Greater Bluefield Junior Chamber
Membership Application

YES!  I am between the ages of 21 and 39 and want to have fun, meet new people, network both professionally and socially, and increase my opportunities for success by becoming a member of the Greater Bluefield Jaycees, The West Virginia Jaycees, The United States Jaycees, and Junior Chamber International.  Dues are $35.50 for the first year.  Dues renewal are $30.50 for each following year.  Membership begins upon receipt of dues payment.  After submitting this form, you may pay your dues online (using PayPal) by clicking on the "PayPal" button shown on the confirmation screen.  Otherwise, please submit a check for $35.50 (referencing this online form) payable to "Greater Bluefield Jaycees" and mail to the address listed below:

Greater Bluefield Jaycees
PO Box 1051
Bluefield, WV  24701

 

Please provide the following personal contact information:

First Name
Last Name
Middle Initial
Street Address
Address (cont.)
City
State
Zip
Date of Birth
Home Phone
Work Phone
FAX
E-mail
Employer
Title
Spouse's Name
Referred by
I would like to refer
Phone
Your Home Page (if any) 

I AM INTERESTED IN THE FOLLOWING:

Social Issues
Environmental Issues
Personal Development
Community Involvement
Meeting New People
Governmental Affairs
Social Security Reform
Medicare Reform
Professional Development
Family & Youth Activities
Sporting Activities
Business Networking
International Affairs
Other (Please List In Blank Provided)
Other
 
Clicking the "Submit Form" button will e-mail the contents of this application to the appropriate Jaycee officer in charge of membership and return you next to a screen describing dues payment options..

 

Click Here!