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APPLICATION

The KENT COUNTY (RI) JAYCEES Membership Application *
First Name: *
Last Name: *
DOB: *
Street Address: *
City: State: Zip: *
Home Phone: *
Cell Phone: *
Email Address: *
Referred By: *
Do you have any friends or family who you think would be interested in joining the Kent County (RI) JAYCEES? *
Do you know of anybody who share our vision of improving the community. If you know anyone like this, please feel free to fill out the referral below and we will be happy to provide them with further information. Their name:
Name:
Address:
Phone:
Name:
Address:
Phone:
Do you understand that The cost of becoming a member is $50.00 *
Do you understand there is a yearly renewal fee of : $ 40.00 *
Do you understand that Prizes are given for Membership(s) Affiliation *
If application submitted on-line, check or money order must be mailed to: Kent County (RI) JAYCEES Membership * P.O. Box 348, W. Warwick , RI 02893 Date check will be mailed