APPLICATION TO JOIN THE KENT COUNTY JAYCEES

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? *	Yes No
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:	Yes No
Name:
Address:
Phone:
Name:
Address:
Phone:
Do you understand that The cost of becoming a member is $50.00 *	Yes No
Do you understand there is a yearly renewal fee of : $ 40.00 *	Yes No
Do you understand that Prizes are given for Membership(s) Affiliation *	Yes No
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