APPLICATION FOR MEMBERSHIP

Fill out this page, print and mail with payment to address below
Name:
Address:
City,State,Zip:
Phone:
Fax:
e-mail:
Profession:

I/We understand and agree that I/we will be bound by the By-Laws of American Polish Council of Long Island and I/We will have one vote. If joining under corporate membership, please designate one person who will have voting rights
_________________________________________________________________
Signature
_________________________________________________________________
Voting Member
INDIVIDUAL MEMBERSHIP:      $10.00
    (entitles members to one vote)
CORPORATION MEMBERSHIP:   $25.00
   (entitles members to one vote)
   (Any number of people from one company. Please include the names of those who wish to be members so we can keep everyone informed via mail.)
Please complete the above form - include additional names if corporate membership - make checks payable to American Polish Council of L.I. and mail to:
American Polish Council of L.I.
Polish Club
329 Peninsula Blvd.
Hempstead, New York 11550