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Membership Form

Join our Women With A Cause! Please fill out the form below to become a member or renew your membership

Membership Form 2026-2027

Forms to Review (Acknowledgment Further Down Form)

Membership

"*" indicates required fields

Beginning with the 2026-27 year, only one membership form can be submitted per member. We now require each paying member to individually review and acknowledge the Conflict of Interest and other required policies.

Annual Membership Dues*

Price:

MEMBERSHIP STATUS & CONTACT INFORMATION

Membership Type*

New Member

Renewing Member

Name*

First Last

Maiden Name

Spousal Information

Spouse First Name Spouse Last Name

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Birthday (MM/DD)*

Year Presented If Debutante

Placement

Queen

First Runner-Up

Second Runner-Up

Interests

Tell us which areas you are interested in volunteering

Planning Events

Board Participation

Liaison with other organizations

Committee Participation

Interests

If interested in volunteering in another way please let us know below!

AFFILIATIONS & DUAL-LOYALTY DISCLOSURE

To ensure compliance with our Conflict of Interest policies, please list any other organizations, non- profits, or boards you belong to, along with any positions held.

Please List Organization and Position (if applicable)

Example: Advocate's Society, Recording Secretary

POLICY ACKNOWLEDGMENTS & COMPLIANCE

Please read and initial next to each section to confirm your understanding and agreement.

Conflict of Interest & Dual-Loyalty*

I agree to disclose any personal, professional, or financial interests that may conflict with my duties. In the event of a board-determined infraction or policy violation, I agree that I will not engage in any form of retaliation against LEGION, the board, or any individual member.

Confidentiality Policy*

I promise to maintain the absolute privacy of all non-public information, including organization financials, proprietary data, Debutante profiles, and the membership database.

Member Code of Ethics*

I agree to uphold the highest standards of integrity, respect, and professional behavior as outlined in LEGION’s guidelines.

GOVERNANCE & LEGAL AGREEMENTS

Please check the boxes below to signify your legal consent.*

Constitutional Adherence: I hereby certify that I have read, understand, and agree to abide by the organization’s Constitution, Bylaws, and all established Standard Operating Procedures and Policies.

Media & Photo Release: By attending any LEGION event, hosted activity, or meeting, I grant permission to LEGION to use my image, likeness or voice in LEGION marketing, promotional and educational purposes.

ATTESTATION & SIGNATURE

By signing below, I certify that all information provided is accurate and that I agree to all terms initialed above.

Today's Date*

Member Name Printed*

Member's Signature*

Parental or Legal Guardian Name Printed (For members under 18 years old)

Parent/Guardian Signature:

Are you paying with credit card or check?*

Paying with a credit card is subject to a 3.5% credit card fee to offset fees.

Credit Card

Check

Credit Card Fee

Price: $0.00

Total

Credit Card*

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