Wilmington Jaycees Membership Application

  First Name:      
  Last Name:      
  Address:      
  City:      
  State:      
  Zip:      
  Date of Birth:      
  Home Phone:      
  Work Phone:      
  Cell Phone:      
  E-mail:    
  Employer:    
  Title:    
  Spouses Name:      
  Referred By:      
  I would like to refer:      
  Phone/E-mail:    
           
  What is your t-shirt size?      
                        
           
   I am interested in the following:      
   
   
   
       
       
       
   
 
           
Yes. I am aware of the $60 annual membership fee*.
* Membership is complete upon the receipt of membership dues and application. Dues for your Jaycee membership are NOT tax deductible as a charitable contribution. 		 
           

 Comments:

Congratulations on your decision to join the Wilmington Jaycees. As part of the application process, we ask that you also fill out our membership survey.  Please click on the submit button below to submit your application and then go back to the membership page to click on the survey button.