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Name:
Address:
Date of Birth:
Phone #:
E-mail:
Employer:
Employer Sponsored:	Yes / No
Referred by:
I AM INTERESTED IN THE FOLLOWING AREAS
Community Involvement	Meeting New People
Sports Activities	Business Networking
Family & Youth Activities	Career Advancement
Enviromental Issues	International Affairs
Personal Development	Other
Membership is $50 Make checks payable to:
The Shelton Jaycees meet on the 2nd Tuesday of each month, from 7:30 - 8:30 pm at the Pine Rock Fire House, 722 Long Hill Avenue in Shelton. For more info call our upcoming events hot line at (203)261-8185 or (203)231-0448. Event info is also available online. www.SheltonJaycees.org www.usjaycees.org www.jci.cc
Print this form and bring it to your first meeting. We look forward to meeting you.