_{Print and fill out this application and send it to}

_{the address on the application.}

 _{Dues are $18.00}

_{for couples and $12.00 for singles}

_{------------------------------------------------------------------}

Po.L.K. of A. Application

Minnesota Parent Klub

Print and mail to

Po.L.K. of A.

661 Birch Ave W

Hector MN 55342

E-mail   gejson@frontiernet.net

New____ Renewal____ Amount Paid $_______

Name_____________________________________

Address___________________________________

City_______________ State______ Zip__________

Phone____________________________________

Birthday/Month/Year His________ Her's __________

Anniversary________