ypsilantijaycees.com - New Member Application

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New Member Application

New Member Application Form
Name *
Address *
City *
State *
ZIP *
Preferred Phone *
Preferred Email Address
Date of Birth *
Is there any contact information you would not like published in the roster?
Do Not Publish the following
Do you have a service or business you would like to advertise through our business directory or newsletter?	Yes No
I prefere to receive my newsletter	By Email By Mail
I wish to sign up as a member of the Ypsilanti Jaycees and agree to pay the $75 membership dues *	I agree
The information above will be sent to our Membership VP, and not on to Paypal.
On the next page you'll be asked to pay your dues via Paypal
The Ypsilanti Area Jaycees will not receive your credit card or any other information from Paypal, only your name & the amount paid.