Miss Wisconsin Polka Booster Application
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Date_______________

Name____________________________________________Age__________

Address________________________________________________________

City___________________________________State_________Zip_________

E-mail (Optional)_________________________________________________

Please answer the following questions:

1) Do you polka dance? If not, would you be willing to learn?

2) Why do you want to be Miss Wisconsin Polka Booster?

3) What would being the Miss Wisconsin Polka Booster mean to you?

4) If you would be chosen to be the new Miss Wisconsin Polka Booster, how would you promote polka's?

Apply By April 1, 2010 and Return To:

Jerry Carey
N88  W33785 Hwy CW
Oconomowoc, WI. 53066
920-474-4545
Member of the Board of Directors

We would like to have you as a Member...
Wisconsin Polka Boosters Inc.
a non-profit public charity organization.