Membership Form For
Polish American
Cultural Institute of Minnesota

Membership Levels:

Patron                                             $150
Donor                                               100
Sponsor                                              75
Household                                           40
Member (includes newsletter)              25

Other:

Pol-Am Only                                      15
1st Class Postage (optional)                  6
ACPC Membership (optional)              5

                               Total Enclosed $

Other Explanations:

With the postal increase this spring we have made the following changes effective immediately. Since non-profit mail is NOT forwarded but returned 75 cents postage due, if you travel south for the winter please add $6 to your basic subscription rate of $15. This ensures you will receive your Pol-Am by first class mail all year long and forwarded by the Post Office to your winter abode.

Anyone else who wishes to receive their Pol-Am by first class mail all year long should add $6 to their renewals.

Please add $5 to the above membership levels, if you wish to join the American Council for Polish Culture (ACPC) through PACIM (a 50% discount)

Contact Information:

Name
Adress
City, State, Zip
Phone Number E-mail

Make checks payable to PACIM and send this form along with your check to:
PACIM
PO Box 18403
Minneapolis, MN 55418-0403