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Membership Application
If you're interested in becoming
a member of the Warren Polka Boosters, please fill out the form to the right and click "Send".

A check for $12.50 per person made payable to "Warren Polka Boosters" should be mailed to:

  Harry J. Kosmala Jr.
  25223 Anchorage Street
  Harrison Township, MI 48045

If you have any questions, please contact a Board Member for more information.

Male Name:
Birthdate:
Female Name:
Birthdate:

Anniversary:

Street Address:
City, State, Zip:
Phone:
Email:

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