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Cleveland Polka Association

Membership Form

Name: Last*

Name First*

Address*

City / State / Zip*

Telephone

Email Address

New / Renewal

Number of years @ $15 per Year

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Dues are $15 per year - per member for US and Canada.

Lifetime Member dues are $100 one time.

Pay on Line with PayPal

OR

Make Check Payable to:

The Cleveland Polka Association

    (or CPA)


Mail Check to:

Anna Slepecky, Membership Person

3920 Granger Road

Medina OH.  44256

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