If you pay by Check OR Money Order,  then fill out this  Form :
NAME:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
TODAY's   DATE:
DEPOSIT:
CHECK
Money Order		 $       . DOUBLE ROOM 
               SINGLE   ROOM(additional amt.) 
RESERV. FOR  THIS  NO. OF PERSONS             ..Clear Form Info
..
.
.
 .. 

                        Fill in form above / print it and send CHECK OR MONEY ORDER of deposit
                            to the address below :

                           1. please print the above form and fax it to me

                          2. Or  just print it and mail the form to me   (by US post office)

                            3. OR ....if you cannot print it, then copy information and send in with payment.
 

 Send deposit to:
    POLKA AMBASSADOR CLUB
      205 OTTO ST
                    BELLE VERNON, PA 15012
                                                            Judy     1-724-929-6019      email:  judi@stringhill.com
                           FAX 1-724-929-6019