Lincoln Jaycees Online - Membership Information and Application

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Lincoln Jaycees

PO Box 85203

Lincoln NE 68501

(402)434-8900

If you are interested in joining the Lincoln Jaycees, please fill out the following Interest Form. Fields with an '*' are required fields. Jaycees must be between the ages of 21 and 40 and want to create a positive change, through volunteerism, in the community.

A representative of the Lincoln Jaycees will contact you about becoming a member. To become a member you must complete all membership requirements and pay the membership fee. Submitting this form does not make you a member, but it gets you on the way!

Membership Application

First Name*

Last Name*

Birth Date*

Address

City

Phone*

Ex:(xxx)xxx-xxxx

Work Phone

Ex:(xxx)xxx-xxxx

Email*

Employer

Job Title

Spouse's Name

Referred By

I WOULD LIKE TO REFER

Person's Name

Person's Phone

Person's Email

I AM INTERESTED IN THE FOLLOWING

Social Issues	Environmental Awareness
Personal Development	Community Involvement
Meeting People	Government Affairs
Professional Development	Family and Youth Activities
Sporting Activities	Business Networking
International Affairs

Lincoln Jaycees - PO Box 85203 - Lincoln NE 68501 - (402)434-8900

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