The PHF Membership Form     Mr. Krzysztof Poraj-Kuczewski, Secretary The Polish Home Foundation 1714  18th Ave, Seattle, WA 98122   I would like to become a supporting member of the Polish Home Foundation in Seattle.   Name .......................................................        Telephone .............................................. Address ............................................................................................................................. Email (optional) ...............................................................................................................   I attach a check for 2003 membership dues written to the Polish Home Foundation (please check one below) __ $15 individual membership __ $25 family membership   Optional: I also attach a donation of  $...........  to be applied toward one of the following: __ cultural fund, __ educational fund, __ medical and emergency fund, __ Polish Home improvement fund, __ general (unrestricted) fund; __ other (please specify): ......................................................... __ Contact me about my gift     Dated .........................................   Signature..................................................     The Polish Home Foundation is a public charity with a 501(c)(3) exempt status and all donations are tax deductible. The PHF issues a donation confirmation letter for tax purposes to every donor by the end of the year.   Donations without specified preferences will be applied towards the general fund.