POLKA SURVEY

Gene Mikrut, Chicago musician and polka columnist, is conducting a survey of polka music spots around the country. If you are interested in submitting information for this survey, print the form, fill in the information and mail it to the address listed below or visit his website at: Gene Mikrut's Site

The Purpose of the survey is to enable vacationeers to coordinate their travels or overnight stays in areas that have polka activity. All information will be published in Gene Mikrut's column, which is a regular feature in the Polka News newspaper.

Polka Information Form

NAME OF ORGANIZATION

STREET ADDRESS

PHONE

CITY

STATE

DIRECTIONS TO CLUB, HALL or LOUNGE - FROM NEAREST INTERSTATE OR US HWY

DAYS AND HOURS THAT YOU HAVE LIVE MUSIC

ADMISSION CHARGE

FOOD=COMPLETE MEALS - SANDWICHES

MEMBERSHIP COST - if applicable

POLICY REGARDING ADMISSION OF NON-MEMBERS

ADDTIONAL COMMENTS:

PRINT and MAIL THIS FORM TO: GENE MIKRUT 24010 Schoolhouse Road, Manhattan Illinois 60442

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