Please consider joining the Polish American Congress of Southern California
Please fill out and submit the Member ship application below and mail the membership dues to:
Membership Director
Polish American Congress of Southern California
633 N. Birchwood Rd., Orange, CA 92869
Individual Annual Membership - $35.00, Family Annual Membership - $65.00
First Name    
Last Name    
Address    
City    
State      
Zip code      
E-mail
Phone Numbers:      
Home      
Business      
What Languages do you speak (please check all that apply)
English      
Polish      
Other      
Citizenship
American Citizen By Birth
By Naturalization
- Month Year
Permanent Resident
Date of Arrival in the United States
- Month Year

As Required by the PAC By-Laws, membership of above applicant is recommended by:
(Please fill in name and phone number below, you must have at least 2)
Recommended by #1
Recommended by #2
Recommended by #3
     
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