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Renew your Membership

Purchaser Name

First

Last

Renewal: Year 2024

Price: $20.00

Member(s) Name(s) for Renewal Year 2024

Renewal: Year 2025

Price: $20.00

Member(s) Name(s) for Renewal Year 2025

Member(s) for Member(s)

Renewal: Year 2026

Price: $20.00

Member(s) Name(s) for Renewal Year 2026

Total

Item Quantity Qty Total

There are no products selected.

Renewal: Year 2024 0 $0.00

Renewal: Year 2025 0 $0.00

Renewal: Year 2026 0 $0.00

Subtotal

Total $0.00

Card Details

Card

Name on Card

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Apply to become a Member

Full Name

First

Last

Date of Birth

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone Number

Email Address

Details Date Email

Agreement

I agree to the membership terms and conditions

Signature

Clear Signature

Date Signed

Membership Registration

Price: $30.00

Total

Item Quantity Qty Total

There are no products selected.

Membership Registration 1 $30.00

Subtotal

Total $30.00

Card Details

Card

Name on Card

🔐 Safe & Secure Payment
All transactions are protected with industry-standard encryption and securely processed by Square. Your card details are private and never visible to us.

Pay for Polish School

Childs Name

First

Last

Total Name Email

Parent or Guardians Name

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Payment

Number of Months

Price: $25.00

Total

Item Quantity Qty Total

There are no products selected.

Number of Months 1 $25.00

Subtotal

Total $25.00

Card Details

Card

Name on Card

🔐 Safe & Secure Payment
All transactions are protected with industry-standard encryption and securely processed by Square. Your card details are private and never visible to us.

Register for Polish School

Childs Name

First

Last

Childs Age

Parent or Guardians Name

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency Contact

Name

First

Last

Relationship to Child

Phone Number

Payment

Number of Months

Price: $25.00

Signature

Clear Signature

Date Signed

Total

Item Quantity Qty Total

There are no products selected.

Number of Months 1 $25.00

Subtotal

Total $25.00

Signature Number Total

Card Details

Card

Name on Card

🔐 Safe & Secure Payment
All transactions are protected with industry-standard encryption and securely processed by Square. Your card details are private and never visible to us.

Donate to the White Eagle Polish Association

Email Total Name

Name

First

Last

Phone

Donation Amount

Total

Item Quantity Qty Total

There are no products selected.

Donation Amount 1 $0.00

Subtotal

Total $0.00

Square

Card

Name on Card

🔐 Safe & Secure Payment
All transactions are protected with industry-standard encryption and securely processed by Square. Your card details are private and never visible to us.