DANK 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:   DANK,   4740 N. Western Avenue,    Chicago, IL 60625-2013

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: 

I am applying for: (please use your mouse to 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.......

 $

DANK Membership Application
Page 2

I / We prefer to join the Chapter:

I/We speak German:                                   Yes   No         

I/We are interested in learning German:   Yes   No

Sponsor:   

                               

Signature: __________________________________

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

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