American Polish Club Inc.
4725 Lake Worth Rd, Greenacres, FL, 33463
Phone: 561-967-1116  Fax: 561-967-1557
Application For Membership
I hereby make application in the American Polish Club and agree to abide by the Bylaws.
NAME:
HOME ADDRESS:
BUSINESS ADDRESS:
DATE OF BIRTH:
HOME PHONE:
BUSINESS PHONE:
PLACE OF BIRTH:
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PRESENT OCCUPATION:
PREVIOUS OCCUPATION:
SEX:
Male
 Female
MARITAL STATUS:
Single
 Married
 Widower
 Divorced
NATIONALITY:
If married what is the Anniversary Date?
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Mothers:
How would you like to receive monthly bulletin?
Mail
E-Mail
 Fathers:
Hours you are available to volunteer per month or year?
I acknowledge the purpose of American Polish Club Inc. and duties and volunteer work of its
members, of honor do hereby swear to abide by regulations contained Corporation's Bylaws and
Charter, and to be available when called upon to assist the club, so help me God.
Signatures:
APPLICANT
 CO-APPLICANT