Membership - Polka Booster Club of America

Membership Form

Join the Polka Booster Club of America!

Your membership helps keep polka music alive and thriving!

Annual Dues:

💃 $15 per person | 🕺$30 per couple

Member Perks:

Exclusive Member Discount
– Enjoy discounted admission at all Polka Booster dances.

Appreciation Punch Card
– Get a punch for each dance you attend. Fill your card and be entered into a special drawing for appreciation gifts!

Member-Only Drawings
– Throughout the year, we have special drawings at our dances exclusive for members only.

Membership Appreciation Picnic
– Join us in July for a fun-filled summer gathering—our way of saying thank you!

Ready to join the fun?

Fill out the form below to join, then submit your payment via PayPal or mail a check.

We can’t wait to welcome you!

First Name

Last Name

Address

City

State

Zip Code

Spouses Name

Anniversary Date (MM/DD/YY)

Birthdate (MM/DD)

Home Number

Mobile Number

Emergency Contact Name

Emergency Contact Phone No.

Membership Payment Method

Check Paypal Other

Newsletter Preference

Print Email

Payment Options:

✔️ Pay Online

– Click the PayPal button below to pay securely with PayPal, debit card, credit card., or Apple Pay.

✔️ Pay by Check

– Make your check payable to Polka Booster Club of America and mail it to:
Polka Booster Club of America
c/o Michael Biesiadecki
25120 Doxtator
Dearborn, MI 48128

💡 Be sure to complete the membership form above before sending payment so we can match your information correctly.