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NEW MEMBER APPLICATION

German American National Congress  (Deutsch-Amerikanischer National Kongress)

      DATE
         
Last Name   Spouse Name
First Name   Spouse Birth Date
Middle Initial   Wedding Anniversary
Address   E-mail Address
City   Child's Name
State   Birth Date
ZIP Code   Child's Name
Phone #   Birth Date
Applicants Birth Date      
         
I am applying for:        
Basic Membership, head of household $30*  $  ______
Spouse Membership  $10  $  ______
Children ages 1-17 years (free) # children  $  ______
Family Member over 18 of same household  $10  $  ______
College Student  $10*  $  ______
     
* The membership fee entitles members to receive the newspaper "German American Journal".

TOTAL:

  $  ______
     
Sponsor:  (optional)    
     
Signature _____________________    

Please Fill out this form and hit the PRINT Button below.
Make check payable to : D.A.N.K. Chapter 13
MAIL this form and your check to:

DANK Chapter 13
2651 Pipestone Road
Benton Harbor, MI  49022