POLISH AMERICAN CONGRESS

CORPORATE MEMBERSHIP APPLICATION

 
PLEASE TYPE OR PRINT CLEARLY

_____________________________________________________________________________________
Name of Corporation or Firm Type of Business

_____________________________________________________________________________________
Corporate Point of Contact Title

_____________________________________________________________________________________
Address (Number, Street, Suite No.)

_____________________________________________________________________________________
(City, State, Zip Code)

_____________________________________________________________________________________
Telephone Number Fax Number E-Mail

MEMBERSHIP CATEGORY: (Please Select One)

[] Corporate Sponsor: Annual Membership = Fee $1000

[] Corporate Patron: Annual Membership = Fee $500

[] Corporate Member: Annual Membership = Fee $100

 
Authorized Signature _____________________________________ Title _______________________

(Print Name) ______________________________________

Date ______________________

Please make your check payable to the Polish American Congress, Inc.
and forward with the application to:

Polish American Congress, Inc.
1612 K Street, NW, Suite 410
Washington, DC 20006

Tel: (202) 296-6955 Fax (202) 835-1565
e-mail: pacwash@polamcon.org

Please Note: Tax deductible contributions gratefully accepted. Please make checks payable to the Polish American Congress Charitable Foundation (PACCF), a 501 (c)(3) non-profit corporation.