P.O. Box 245 Waterloo, IA 50704 Phone - (319) 231-4439


	• 2008 Waterloo Open July 16-20 Click Here


	• 2008 Saturday, July 5th 6:00p.m.-midnight Click Here


	• 28th Annual Canoe Race - • June 14-15 Click Here



	• Kids Helping Kids


	• Gift of Giving

Application for Membership

Yes, I am between the ages of 21 and 40 and want to increase my opportunities for success by becoming a member.

Name

Address

City State Zip

Date of Birth (if applying for membership)

Home Phone Work Phone

Email

Employer (if applying for membership)

Title (if applying for membership)

Spouse's Name (if applicable)

Referred By

I would like to refer

Phone

Check all that apply:

Yes, I want to be a member and will mail my $60.00 membership fee.

Send me more information on Waterloo Jaycee Membership.

Have a member call me about becoming a Waterloo Jaycee.

If paying by mail, please mail your annual $60.00 membership fee to:

Waterloo Jaycees, P.O. Box 245, Waterloo, IA 50704

Dues for your Jaycee membership are NOT tax deductible as a charitable contribution.

Membership Vice President - Kim Loy, her number is 290-1036 or email - info@waterloojaycees.org