Membership Form Join our Women With A Cause! Please fill out the form below to become a member or renew your membership Print Membership Form "*" indicates required fields Annual Membership Dues QuantityPlease note the price includes processing and handling fees. Price: How many memberships are you registering?Please enter a number from 1 to 3.Name* First Last Maiden NameMaiden Name Spousal Information Spouse First Name Spouse Last Name Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Debutante Year Birthday* MM slash DD slash YYYY Please list any celebrations of life or death that you would like us to know aboutExamples include: Birth of Children, Wedding, Death in Family, etc.InterestsTell us which areas you are interested in volunteering Planning Events Board Participation Liaison with other organizations Ball Participation Sponsorship/Fundraising Information for Member 2 Please fill out the information for the second member.Name* First Last Maiden NameMaiden Name Spousal Information Spouse First Name Spouse Last Name Address* Same as previous Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Debutante Year Birthday* MM slash DD slash YYYY Please list any celebrations of life or death that you would like us to know aboutExamples include: Birth of Children, Wedding, Death in Family, etc.InterestsTell us which areas you are interested in volunteering Planning Events Board Participation Liaison with other organizations Ball Participation Sponsorship/Fundraising Information for Member 3 Please fill out the information for the third member.Name* First Last Maiden NameMaiden Name Spousal Information Spouse First Name Spouse Last Name Address* Same as previous Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Debutante Year Birthday* MM slash DD slash YYYY Please list any celebrations of life or death that you would like us to know aboutExamples include: Birth of Children, Wedding, Death in Family, etc.InterestsTell us which areas you are interested in volunteering Planning Events Board Participation Liaison with other organizations Ball Participation Sponsorship/Fundraising Total Are you paying with credit card or check? Credit Card Check Credit Card*Card Details Cardholder Name Please send your check to: Legion of Young Polish Women c/o Membership Director PO Box 56-110 Chicago, IL 60656 Checks can be made out to: Legion of Young Polish Women
