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JOIN US

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.

Membership Application

Please complete this application (one for each person) and return to:

SHIRLEY LANGENHORST
98 BIRCH LANE
GERMANTOWN, IL 62245-2002
618-523-4364

Membership dues $8.00 per person per year.
Junior members (age 17 and under) $3.00 per person per year.

Name____________________________________  Todays date  _________

Address_________________________________________________________

City_______________________________State_____Zip+4______________

e-mail __________________________________Phone number (________)__________-__________ 

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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Page last updated June 2018