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POLISH LIBRARY IN WASHINGTON 1503 21st Street, N.W. Washington, DC 20036
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MEMBERSHIP APPLICATION |
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| Yes, I/we would like to become a member of the Polish Library in Washington: | |
| Name: | Contact_FullName |
| Organization: | Contact_Organization |
| Address: | Contact_StreetAddress |
| Contact_Address2 | |
| City: | Contact_City |
| State: | Contact_State |
| Zip Code: | Contact_ZipCode |
| Phone: | Contact_HomePhone |
| e-mail: | Contact_Email |
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I/we choose: fee |
Please accept my/our charitable (tax free) donation in the amount of: $ Donation (check enclosed.) |
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In addition I/we would like to say:
Signature: _____________________________________ Date: ___________________ |
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