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Renew your Membership

Purchaser Name

First

Last

Year 2025 Name

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

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

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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

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

of Name Address

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Pay for Polish School

Childs Name

First

Last

Parent or Guardians Name

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Payment

Payment Parent Guardians

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

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Register for Polish School

Childs Name

First

Last

Childs Age

Parent or Guardians Name

First

Last

Contact Address to

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

Card Details

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Donate to the White Eagle Polish Association

Name

First

Last

Phone

Amount Email Name

Donation Amount

Total

Item Quantity Qty Total

There are no products selected.

Donation Amount 1 $0.00

Subtotal

Total $0.00

Square

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🔐 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.