OFFICERS AND DIRECTORS
A non-profit club dedicated to the promotion of polka music. Your participation as a member is most welcome and will be much appreciated.
Please complete this application (one for each person) and return to:
SHIRLEY LANGENHORST OR MICHAEL BERGMIRE 98 BIRCH LANE 301 FAWN MEADOWS DRIVE GERMANTOWN, IL 62245-2002 BALLWIN, MO 63011-3818 618-523-4364 636-527-8115
Membership dues $6.00 per person per year.
Junior members (age 17 and under) $3.00 per person per year.
Name____________________________________ Todays date _________ Address_________________________________________________________ City_______________________________State_____Zip+4______________
Enclose check payable to St. Louis Metro Polka Club
Signature of Applicant _____________________________________________________
Signature of Sponsor _______________________________________________________
(member in good standing)
Yes _____ You may publish my name, address and telephone number on a membership roster.
No _____ I do not wish to have my name, address and telephone number on a membership roster.
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