LI Center Member Application

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New Members: Use this form to apply for membership with the Long Island Center.
Existing Members: Use this form to create an account for access to members-only section on this website.

Please fill out the form below.
* This Field is required Information for: First Name : Please enter your real first name.
Information for: Middle Name : Please enter your real middle name.
* This Field is required Information for: Last Name : Please enter your real last name.
* This Field is required Information for: Email : Please enter a valid e-mail address. A confirmation email will be sent to this address upon registration.
* This Field is required Information for: Username : Please enter a valid username. No spaces, at least 3 characters and contain 0-9,a-z,A-Z
* This Field is required Information for: Password : Please enter a valid password. No spaces, at least 6 characters and contain lower and upper-case letters, numbers and special signs
* This Field is required Information for: Verify Password : Please enter a valid password. No spaces, at least 6 characters and contain lower and upper-case letters, numbers and special signs
* This Field is required
Information for: How did you hear about the LI Center? : <span style="font-family: Verdana;"><span style="font-size: x-small;"><br /></span></span>
Information for: Mail Preference : <p><span style="font-family: Verdana;"><span style="font-size: x-small;"></span></span></p>
Information for: Profile image : Select "upload profile image" to add your picture or logo to your profile.

Your image will be resized if needed to a maximum dimension of 200 pixels width x 500 height automatically, but your image file should not exceed 2000 KB.

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Click "Join Here" to complete the application and receive further instructions.