Membership Application 2022-2023
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Email *
Personal Information Name:
Name:
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Today's Date: *
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Birthday:
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Best Contact Phone Number:
E-mail Address:
Address:
Emergency Contact (Name & Phone):
How did you hear about us? Please Indicate... PJWC Member / Friend: Community Event: (Please tell us which event) Other: Share a bit about yourself with us! Do you social network? (Facebook, Instagram, Snapchat, Linkedin, Twitter, Meetup)  *
Share a bit about yourself with us! Do you social network? (Facebook, Instagram, Snapchat, Linkedin, Twitter, Meetup)
Do you work in the community or surrounding areas?
Are you involved in the community; what other type of activities/groups/ organizations?
Please Acknowledge and Accept Below:
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Do you agree to the below: (Sign below the image) *
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Please Acknowledge for Acceptance of Terms *
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