DANK Fox Valley Membership Application

Please fill out the application below, then print it on your home printer by selecting
File, Print, Print Selection, and mail the completed application with your check made out to DANK to:

Willi Gohs, DANK Fox Valley Membership, 2S904 Heritage Glen Ct., Batavia, IL 60510

Date:               

First Name:         Last Name: 

Applicant Birth Date: (If Student or Under 18 Years Old)         Month  Day  Year

Spouse Name:     Wedding Anniversary:    Month  Day  Year

Child Name:        Birth Date:                      Month  Day  Year

Child Name:        Birth Date:                      Month  Day  Year

Child Name:        Birth Date:                      Month  Day  Year

Child Name:        Birth Date:                      Month  Day  Year

Address:         

City:                   State:     ZIP Code:

Phone:                E-mail Address: 

 

 

 

 

 

DANK Fox Valley Membership Application
Page 2

 

I am applying for: (please check type of memberships and fill in appropriate cost block on right)

Basic Membership, Head of Household ($30)* .............................................................$

Spouse Membership ($10).............................................................................................$

Children ages 1-17 years old as indicated above (Free)...................................................$ Free

Family Members over 18 of same Household ($10 per person).......................................$

College Students ($10 per student)*...............................................................................$

                                                                                                                    TOTAL:....... $

 

    I / We prefer to join the Chapter: Fox Valley

I/We speak German:                                   Yes   No         

I/We are interested in learning German:   Yes   No

                               

Signature: __________________________________

*The Membership Fee entitles members to receive the newspaper "German American Journal"

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