Wisconsin Polka Booster
Membership Application Form
Single_______ Married________
Name___________________________________________________________________
First
Name
Last Name
Spouse’s Name___________________________________________________________
Address_________________________________________________________________
City_______________________________
State______________
Zip_______________
Phone______________________________
Occupation___________________________
Birthdays: Man______________________
Woman______________________________
Anniversary_________________________________
(month & day only)
Additional Information – please
check if:
______ Band Leader ______ Hall Owner
Name of Organization______________________________________________________
Type of Membership:
________ Husband & Wife _________ Single __________ Child of Member
Make
Checks Payable to: Wisconsin Polka Boosters, Inc.
Forward
Completed Form To:
The
Wisconsin Polka Boosters, Inc.
PO
Box 746
Elm
Grove, WI 53122-0746
$15.00
to join