WHITE ROSE POLKA DANCERS ASSOCIATION, INC.

APPLICATION FOR MEMBERSHIP

(MUST BE SUBMITTED FOR EACH MEMBER)

 

ANNUAL DUES:  $15.00 PER MEMBER

 

 

NAME ______________________________________________________________DOB ___________

 

ADDRESS__________________________________________________________________________

 

ANNIVERSARY DATE:_______________________

 

TELEPHONE NUMBER_______________________________________

 

E-MAIL ADDRESS__________________________________________

 

I CERTIFY THAT I WILL ABIDE BY THE RULES AND BY-LAWS OF THE WHITE ROSE POLKA DANCERS ASSOCIATION, INC.

 

 

SIGNATURE________________________________________________________________DATE __________

                                                                                                                                          

FOR NEW APPLICANTS, COMPLETE IF APPLICABLE.  I AM CURRENTLY BEING SPONSORED BY A PRESIDENT OF ANOTHER POLKA CLUB OR A WRPDA MEMBER IN GOOD STANDING.

 

PRESIDENT/SPONSORING MEMBER ___________________________________________

 

o    I DO NOT WISH TO RENEW MY MEMBERSHIP WITH THE WHITE ROSE POLKA DANCERS ASSOCIATION INC.

o   CHECK IF NEW ADDRESS

 

NOTE:  IF DUES ARE NOT RECEIVED BY MARCH 1, THE NEWSLETTER WILL BE STOPPED.

 

MAKE CHECKS PAYABLE TO THE WHITE ROSE POLKA DANCERS ASSOCIATION (WRPDA).

MAIL TO:                    CAROL DRUECKHAMMER

                                  3150 TUNNEL HILL ROAD

                                  SEVEN VALLEYS, PA  17360