Friends of Poland
2002 Membership Form
Name:_________________________________
Mailing Address:________________________
City/State/ZIP/Country:_______________________
Home Telephone:___________ Work Telephone:
Email Address:___________ 2nd Email Address:
Occupation & Employer:_________________
____RPCV ____Former
PC Poland Staff Other:
Description of service in Poland: (Group number, years of service and site(s), type of
work)
___________________________________________
___________________________________________
(____ ) $15 Annual
Friends of Poland Dues
( ) $20 Common
Household Friends of Poland Dues
( ) $40 Friends
of Poland and National Peace Corps Association Dues.
( ) $____
Recently returned or financially constrained
RPCV. Please enclose a check for whatever you can afford and/or consider donating
some of your time to help the group.
( ) $____
Other donation
Please use
reverse side of the form if you need additional space.
Print this
form and send it with your check (payable to Friends of Poland) to:
Friends
of Poland
PO Box 370504
Milwaukee, WI 53237
mail@friendsofpoland.org