Sign-up
Membership Type *
2012 Family
($40.00 for period up to 12/30/2012)
(covers you, your spouse or domestic partner, and your children under age 18)
2012 Individual
($25.00 for period up to 12/30/2012)
2012 Student
($15.00 for period up to 12/30/2012)
(send copy of student ID to: info@austinpolishsociety.org)
Payment System *
PayPal
secure credit card payment
Your Name *
Your First & Last name
Your E-Mail Address *
A confirmation email will be sent
to you at this address
Choose a Login Name (User ID) *
It must be 4 or more characters in length and may
only contain small letters, numbers, and
the underscore '_'
Choose a Password *
Must be 4 or more characters
Confirm your password *
Enter password again
Cell Phone *
Home Phone
Work Phone
Spouse Name
(Family memberships only)
Spouse Email
(Family memberships only)
Spouse Phone
(Family memberships only)
Address *
City *
State *
Zip *
Country *
18 or older? *
Yes
