Membership Application

Dear Prospective PAS Member:

To apply for a membership in the Polish - American Society of Memphis, please complete the form below and return, with payment, to the PAS treasurer.

First Name *

Last Name *

Address *

City

State

ZIP/Postal Code

Phone Number *

Email Address *

MEMBERSHIP DUES:

SINGLE - $25COUPLE - $50

Spouse First Name

Spouse Last Name

CHILDREN YOUNGER THAN 18:

First Name

Last Name

Age

First Name

Last Name

Age

First Name

Last Name

Age

I hereby apply for membership in the Polish-American Society of Memphis. By applying for membership, I agree to abide by the PAS bylaws.

Signature *

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Date *

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