Membership Application
Plainfield Area Jaycees
Membership Form
Please print out this form and bring to any Jaycee meeting.
Name:
Address:
City:
State and Zip Code:
Two letters Zip
Email Address:
Home Phone Number:
Work Phone Number:
Date of Birth:
Must be between ages 21 and 40
Occupation:
How did you find us?
Another Jaycee
Information on Website
Someone Else
Stumbled onto Website
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