Wisconsin Polka Boosters
Membership Application / Renewal
Please Print
Single________ Married________ Month________ Date________
Name___________________________________________________________________
First Name Last Name
Spouse’s Name___________________________________________________________
Address_________________________________________________________________
City_______________________________ State______________
Zip_______________
Phone______________________________
E-mail______________________________
Occupation___________________________
Please check if applicable: Band Leader ( ) Hall Owner ( )
Name of Band, Hall, or Organization________________________________
New Member being sponsored by___________________________________
Membership Fee: $22.00 per person or couple
For more information call: Kathy Draver at 414-761-0750
Make Checks Payable to: Wisconsin Polka Boosters
Please print this page, fill out
and send to:
Kathy Draver
6631 S. 26th St.
Oak Creek, WI 53154
Thanks for becoming a Wisconsin Polka Booster Member