West Virginia
                                   Junior Chamber of Commerce
                                   January 2001 Quarterly
                                   "The Gathering" - Saturday
                                   Dinner/Awards/Dance - $30.00*
                                                    Partial Registration

This form is for partial on-line registration information for Saturday Hospitality, Dinner, & Dance 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 Friday partial registration or full weekend registration.  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 partial 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 $30.00 (if before January 10, 2001) or *$35.00 (if after January 10, 2001) to the address below:

Greater Bluefield Jaycees
PO Box 1051
Bluefield, WV  24701

Please provide the following registration information:

 Chapter Name
Street Address
Address (cont.)
Work Phone
Home Phone

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