Your first name*
Your last name at the time of membership *
Your present last name(if different)
   
Last year you were active *
   
Your e-mail address*
 
Home Phone Number
Cellular Phone Number
May we send text messages to your cell
Work Phone Number
 
Street Address
City
State
Zip
   
Current Employer
Job Title
 
Have you aged out? (Are you over 40)
 
Would you like to be added to our mailing list?
 
Would you like information on the 2008 60th Anniversary Celebration?
 
Would you like your information to be shared with Hickory Jaycees members for business networking purposes?
 
Tell us about your favorite project when you were a Jaycee
 
Any comments you would like to make
   
 
 
 
All information collected will be reviewed and secured by the Hickoy Jaycees at no point will this info be made public or shared with others.