Torrance Jaycees

MEMBERSHIP APPLICATION

YES! I am between the ages of 18-40 and want to make a difference in Torrance and the surrounding communities by joining the Torrance Jaycees! Please fill out the information below, and a membership representative will contact you shortly.

First: *

Middle:

Last: *

Address Line 1: *

Address Line 2:

City: *

State: *

Zip Code: *

Email Address: *

Birthdate: *

Home Phone: *

Work Phone:

Mobile Phone:

Fax:

Company Name:

Work Title:

Referred by:

Questions or Comments:

38.103.63.18 - Friday, July 4, 2008

*Indicates a required field.
**Personal information gathered by the Torrance Jaycees will be used only for purposes of maintaining our membership database, and supplying the required information for membership to the California Jaycees, United States Jaycees and Junior Chamber International. Our membership database is used to inform our members of upcoming events, and distribution of periodic email and newsletters. No part of this data will be sold or distributed to other parties.