Home :  Membership Application 
Membership Application
Last Update: January 01, 2007

If you are interested in joining the West St. Louis County Jaycees, please fill out the form below and click SEND.

You must be between the ages of 18 and 40 to join the Jaycees as a full member. If you do not fall into this age range, but would still like information about the Jaycees, please email us at info@westcojcs.org or fill out the request form.

  * Required fields

* Name:		* Birthdate:	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988
* Address:
* City:	* State: * Zip:
Home Phone:		Work Phone:
Email:
Spouse's Name:		Employer:
Referred by:		I would like to refer:
Comments:
Areas of Interest (Please check all that apply):
Environmental Issues		Family Activities
Governmental & Political Affairs		Young Adult Education & Involvement
Personal Development		Sporting Activities
Community Development		Social Events
Business Networking		Elderly Assistance
Professional Development		Other: