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Please print out and mail completed application with dues to:
International Press Club, 300 N. State Street 2928, Chicago IL 60610-4817

As an applicant for  (member category) _______________ in the International Press Club of Chicago, I submit the following information so that the Committee may consider my qualifications and status.                           
Name:                                                                                
(Optional) Spouse Card - spouse's name:
Home street address:                                                                         Apt. #
City:                                                             State                    Zip
Home phone:                                             Home fax:                      
E-mail address:                                                 @
Employer (company name):
Street address:
City:                                                              State                   Zip
Position:                                   Phone:                                     Fax:
To comply with the IPCC Constitution and By-Laws, applicants must list names of employing news media with exact dates (month & year) of past service in world or domestic working press:
Employing media           Position           Service Dates            Location
1.
2.
3.
4.
List two or more working press and their organizations, who are personally familiar with your employment:
1.
2.
 
The Admissions Committee welcomes any additional information which will assist it in evaluation of the applicant's qualifications for membership.
I authorize the Admissions Committee to make any relevant inquiries with the facts set forth herein.
Signature:                                                                          Date: