DANK Membership Form

Please fill out the form below by typing in the spaces, and print it out on your home printer.
Then mail the printed page with your filled out information and payment to:

DANK
Membership
4740 N. Western Avenue, Suite 206
Chicago, IL 60625-2013

	Date:
Applicant Info	First Name:		Last Name:
	Birthday:	/ /

Additional Members	Spouse Name:		Birthday:	/ /
		Anniversary:		/ /
	Child Name:		Birthday:	/ /
	Child Name:		Birthday:	/ /
	Child Name:		Birthday:	/ /
	Child Name:		Birthday:	/ /

Contact Information

Street Address:

City:

State:

ZIP:

Primary Phone:

Email:

Memberships	Basic Membership, Head of Household*	x $30.00	=	$
	Spouse Membership	x $10.00	=	$
	Children ages 0-17	x $0.00	=	$ FREE
	Family Members 18+ of Same Household	x $10.00	=	$
	College Students*	x $10.00	=	$
	LIFE MEMBERSHIP	x $500.00	=	$
(click 'Update' next to each membership type before calculating total) Total:			=	$

Preferred Chapter to Join...

Sponsor:

I/We Speak German:	I/We Are Interested In Learning German:
Yes No	Yes No

Signature:

_______________________________

*The Membership Fee automatically includes a subscription to the "German-American Journal" newspaper

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