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THE POLISH AMERICAN CLUB OF MIAMI INC.

Established 1941

MEMBERSHIP APPLICATION

Personal Information

First Name

Last Name

Email *

Phone *

Date of birth *

Nationality *

Primary Residence Address

Street Address

City

State

Country

Postal Code

Membership Type

Please upload copy of Your driver license

Membership Type

Active Member: $150

Life-time Member: $600

Supporting Member: $150

Corporate Member: $5,000

What is your occupation?

What are your reasons for joining the club?

Date:

Who Recommended You

First Name 1

Last Name 1

Phone Number 1

First Name 2

Last Name 2

Phone Number 2

PACOM Membership Application – Authorization

By clicking “Submit”, I confirm that I am eligible for membership in the Polish American Club of Miami (PACOM) through Polish descent, heritage, or marriage.
I authorize PACOM to verify the information provided and to contact the referrals I have listed for confirmation.
I agree to upload a copy of my driver’s license and, if applicable, proof of Polish descent or marriage for verification.
I understand that a $25 non-refundable application fee and annual membership dues will be required after approval.

I agree to terms & conditions provided by The Polish American Club of Miami (PACOM). By providing my phone number and email, I agree to receive text and email messages from PACOM.

THE POLISH AMERICAN CLUB OF MIAMI INC.

382 NE 191ST STREET ∙ PMB 509539 ∙ MIAMI, FL 33179-3899

Contact info: [email protected]