West Virginia
                                   Junior Chamber of Commerce
                                   January 2001 Quarterly
                                   "The Gathering" - Weekend*
                                                    Full Registration

This form is for full on-line registration information only.  If you got here by mistake, please click the "Back" button on your browser and then click the proper area of the "Sunrise Jaycee Crest" to choose the appropriate link for partial registrations (there will be two partial registration options).  After filling out this registration and clicking the "Submit Form" button, you will be returned to a data confirmation screen where you will then be directed to click on a "PayPal" icon.  From there you will be able to pay your registration fee with a credit card or bank account.  

If you don't wish to pay your registration electronically on-line, then print this page out on your printer and return your check or money order for either $35.00 (if before January 10, 2001) or *$45.00 (if after January 10, 2001) to the address below:

Greater Bluefield Jaycees
PO Box 1051
Bluefield, WV  24701
 

Please provide the following registration information:

Name
 Chapter Name
Street Address
Address (cont.)
City
State
Zip
Work Phone
Home Phone
FAX
E-mail

Mark L. Williams
Copyright 2000 Greater Bluefield Jaycees.  All rights reserved.
Revised: December 05, 2001