A JACL membership is a great gift for a loved one or friend. Simply check the box below and complete

the rest of the membership form. Indicate that this is a gift membership within the comments section.

Thank you.

 

Check this Box if this is a new membership registration

 

Check this Box if this is a renewal 

 

Check this Box if the is a Gift Membership 

 

Date  

 

Enter the new member's name  

Spouse name if applying for Couple/Family/1000/Century/

 

Mailing Address:

 

Address 

City       

State     

Zip code

 

Select Membership Level  Individual $65.00 Couple/Family $110.00 Thousand Club $100.00 Century Club $175.00 Millenium Club $1000 Spouse(1000/Century Member) $37 Spouse Millenium Club $36.00 Student/Youth $30.00 Thousand Club Lifetime member $3000 Century Club Lifetime member $5000

 

Email Address to send confirmation

 

Telephone number 

 

Additional Comments