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Annual Dues: $30 per person, $50 per couple, $25 per senior (age 62 and over)
(checks payable to the ICBE in January)

Please remit to: ICBE, P.O. Box 177, Edgewater, NJ 07020 (201-313-9977)

Name(s) __________________________________________
Address __________________________________________
Phones: Home ____________ Cell __________ Work __________
E-mail Address ____________________ Fax ______________

Are you a registered voter in Edgewater?

How did you hear about the ICBE?

Do you know anyone who is a member of the ICBE? If yes, please list.

Have you ever worked for the Borough of Edgewater or affiliated professionals? If yes, please describe.

Have you ever sat on any Edgewater boards or committees? If yes, please list.

What business, trade, social, community, or political organizations are you presently affiliated with?

I/We, the undersigned, understand that the ICBE is a private club and reserves the right to admit, deny, and/or remove any members it believes does not abide by the Club's charter, bylaws, mission statement, and any other governing principles the club promotes and adheres to. I/We attest that the information provided in this application is the truth, without any intent to deceive or mislead. I am/We are aware that any false information provided herein may be grounds for denying or terminating my membership at the discretion of the Executive Committee on advice of the membership committee.

Applicant's Signature _____________________ Date ___________
Spouse's/Partner's Signature ________________ Date ___________
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