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 |
HAROLD SUMOWSKI 111 ROBIN HOOD DR TROY MO 63379 636 462-5828 |
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______________ 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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St. Louis Metro Polka Club Home PagePage last updated June, 01 2006