Membership

Join us!
Become a Polka Booster Today

Anyone can join the Polka Booster Club of America. 

Membership is just $15/year per person, and runs from Jan-Dec of the calendar year. 

Membership gets you discounted prices at our dances & picnics, membership punch cards, and special raffles and prizes throughout the year.

Membership can be paid online using a credit or debit card, Apple/Google Pay ,or Venmo through PayPal. You can also send us a check.

Please fill out the membership form below. Payment information is below.

Membership Form

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Name *

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Address *City *State *Zip Code *Home Phone Number *If you don’t have a home phone, enter your cell phone number.Cell Phone Number *If you don’t have a cell phone number, enter in your home number.

Preferred Contact: *

• Home Phone
• Cell Phone

Email *

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How would you like to receive your monthly newsletter (pick one): *

• Email
• USPS Postal Mail

Date of Birth (MM/DD) *Spouse's First & Last NameAnniversary Date (MM/DD/YYYY)Emergency Contact First and Last Name *Emergency Contact Phone Number *
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Payment Information

If you perfer to pay by check, please make the check payable to: Polka Booster Club of America

Then mail the check to:
Polka Booster Club of America
c/o Michael Biesiadecki
25120 Doxtator
Dearborn, MI 48128

To pay electronically, use the button below.

Become A Member