MEMBERSHIP APPLICATION
 

Please check the appropriate category

___ Regular $25/yr         ___ Patron $50/yr         ___ Benefactor $100/yr

   ___ Institutional $250/yr         ___ Life $2,500

Name ______________________________________________________

Address _____________________________________________________

City ______________________________ State ______ Zip ____________

Phone (_____)  ______________________

AMOUNT ENCLOSED $_______________

Visa/ MasterCard/ Discover: Call (773) 782-2601 8:30 - 4:00, M-F
 

Please make check payable to:
THE POLISH MUSEUM OF AMERICA
Please send to:

PMA Membership
984 North Milwaukee Avenue
Chicago, Illinois 60642

Tel (773)384-3352     Fax (773)384-3799
501(c)3 under IRS Code