Application for Membership

Polish American Club, Inc.

  Of St. Paul, MN

       Date: _______________________  

          Membership Dues:   Couple   (Husband & Wife)            $35.00 +  $5.00  =  $40.00

                                       Single                                                $25.00  +  $5.00  =  $30.00

                                                 Initiation Fee of $5.00                                   

       Name or Names: ________________________________________________________  

       Address: ______________________________________________________  

       City:__________________________     State: _________  Zip:__________ 

       Telephone: Home:_____________________    Work:__________________  

       Employed by:___________________________________________________  

       Occupation:_____________________________________________________ 

          email address:_____________________________________________

              Type of Membership: Regular  

       Sponsor: _____________________________________       

              (Please mail and enclose check with application.)

POLISH AMERICAN CLUB, INC.

Application for Membership

1003 Arcade Street

St. Paul, Minnesota  55106