Become a Member

Name:

Were you ever a JOOI Member?:

Yes

Are you currently a full-time college student?

Yes

HOME ADDRESS

HOME ADDRESS

Street:

City:

State/Province:

Zip/Postal:

Home Phone:

Email:

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BUSINESS ADDRESS

Firm Name:

Type of Business:

Street:

City:

State/Province:

Zip/Postal Code:

Business Phone:

Email:

Fax:

Business Position or Title

May we contact you at work?:

Yes

YOUR SIGNATURE INDICATES YOUR ACCEPTANCE OF THIS INVITATION.

YOUR SIGNATURE INDICATES YOUR ACCEPTANCE OF THIS INVITATION.

Print Name:

Date

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Individuals who have committed sexual offenses against children may be denied membership and/or have their membership revoked.

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Thank you for your interest in becoming a member of the Vandalia-Butler Optimist Club!