The Polish-American Club
of Columbus, Ohio
P.O. Box 14960, Columbus, OH 43214
PACColumbus@hotmail.com

Membership Form
Please print or type 

Name:…………………………………………..…….. E-mail: ……….…….……….………... 

Address: ……………………………………………………………………………….……….… 

City: …………………………………………………… State: …………. Zip: …..…….……… 

Telephone Home: ……………………………..……. Work: ………………………………….. 

Please provide names and birthdays for all members: 
(Note family membership is Mother, Father, and minor children.)

Name: ………………………………………………… Birthday: ………………………………..
Name: ………………………………………………… Birthday: ………………………………..
Name: ………………………………………………… Birthday: ………………………………..
Name: ………………………………………………… Birthday: ………………………………..
Name: ………………………………………………… Birthday: ………………………………..
Name: ………………………………………………… Birthday: ………………………………..

Regular Membership			___$15 Individual		___$25 Family 
Senior Citizen (over 60 & retired)		___$10 Individual		___$15 Family 
___New Membership	___Renewal Membership

Date: …………………….		Signature ………………………………………………... 

Make checks payable to: The Polish American Club. 
Send to: The Polish American Club, P.O. Box 14960, Columbus, OH 43214 

Please check the areas you are most interested in: 
___ Membership Recruitment				___ Finance / Investment / Fund Raising 
___ Dances ___ can help at dances 			___ Being a Translator (as needed) 
___ Wigilia / Andrzejki / Parties ___ can help 		___ Youth Group ___ be leader ___ be helper 
___ Polish Classes ___Teach ___ Learn 		___ Arts / Crafts ___ Teach ___ Learn 
___ Newsletter Publicity ___ have computer 		___ Building Committee (find a clubhouse) 
___ UN Festival ___ Food Booth ___ Cultural Booth 	___ Genealogy 
___ Worthington Days ___ Cook ___ Bake ___Work Booth 
___ Other 

White - Membership Committee		Yellow- Newsletter Editor