We are now accepting online payments!!!

Membership is $15/year and runs from January – December.

Please fill out the membership form below and hit submit.

You’ll be directed to a website where you can fill out your payment information.

We accept all credit cards, including Google Pay and Apple Pay!

In the form below, all required fields are marked with an asterisk. Please make sure that your emergency contact information is accurate.

Rest assure, that your information will not be shared with any third party.

If you would prefer to pay your membership by check, please make checks out to Polka Booster Club of America
Mail the check to:
Polka Booster Club of America
c/o Michael Biesiadecki
25120 Doxtator
Dearborn, MI 48128

Membership Cards:

If you would like to receive a membership card, please send a self-addressed stamped envelope to:
Polka Booster Club of America
c/o Mindi Tietz
32948 Slocum Dr.
Farmington, MI 48336

Polka Booster Membership Form:

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

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 *

Email

Confirm Email

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

• Email
• USPS Postal Mail

Date of Birth (MM/DD) *

Spouse's First & Last Name

Anniversary Date (MM/DD/YYYY)

Emergency Contact First and Last Name *

Emergency Contact Phone Number *

Submit

Thank you for your support.

If you should run into any issues or have any questions, please send us an email at PolkaBoosterClubOfAmerica@gmail.com.