Miss Wisconsin Polka Booster Queen 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 Queen?

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

4) If you would be chosen to be the new Miss Wisconsin Polka Booster Queen, 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
Manager of Polka Promotions

We would like to have you as a Member...
Federal Tax ID#  31374 · WI. Sales Tax No. 048863
Wisconsin Polka Boosters Inc.
a non-profit public charity organization.