Polish American Congress, Inc
Northern California Division

Privacy assurance: All information will be kept strictly confidential and not used for any purposes other than membership and communication within the PAC.

    Mr. Mrs. Ms. Dr.

Last Name First Name M. I.
Address Residence Phone
Addr. Line 2 Business Phone
City State Zip Fax
Occupation E-Mail

    By birth     Naturalized
American Citizen
Permanent Resident
    Languages Spoken:     English   Polish

Please enter your email address (for faster handling), or your telephone number (including area code) into the field to the right. Entering this information shall be accepted as your signature. The PAC will use this information to confirm your membership request.

Electronic Signature of Applicant

What to expect:
  1. You will be contacted (either by automated email or a phone call from the PAC board member) to verify your application.
  2. The PAC members providing recommendation will be contacted to confirm your application.
  3. Upon completion of your application, you will be asked to pay the annual membership fee of $50.00. You will be able to do so either through PayPal, or by sending a check to: Polish American Congress, Northern California Division, 3765 Deer Trail Ct, Danville, CA 94506-6025.
The estimated time for completing the application process is 1-2 weeks.

We appreciate your interest in joining the Polish American Congress Northern California Division!
[TBD: contact information in case of questions ...]

As required by the PAC Bylaws, membership of a new applicant needs to be recommended by two PAC members.

Please provide contact to two PAC members to verify the recommendations.
The contact information could be either in a form of an email address (for faster handling), or a telephone number (including area code):

PAC Members providing recommendation: