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To: White Eagle Association
Re: Membership Application
I am of Polish decent and request to be a member of your association.
Name
*
First
Last
Referred by (optional)
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone number
*
Email
*
Explain Polish heritage
*
Membership
$10.00 Membership Fee
Seniors (over 65) free
(ALL membership dues are designated for scholarships only)
Submit