Member Application

Member Application

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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?
		M L XL XXL Other

I am interested in the following:
		Social Issues	Environmental Issues	Personal Development
		Community Development	Meeting New People	Governmental Affairs
		Business Networking	Sporting Activities	Family & Youth Activities
		International Affairs	Other:

Yes! I am between the ages of 21 and 40 and want to increase my opportunities for success by becoming a member of the U. S. Junior Chamber.

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.

Send mail to Adam Zewe with questions or comments about this web site.
Last modified: 03/07/2009

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