AJRA Online Membership Form
1st Member's Name
*
First Name
Last Name
1st Member's Date of Birth
*
-
Month
-
Day
Year
Date
2nd Member's Name
First Name
Last Name
2nd Member's Date of Birth
-
Month
-
Day
Year
Date
3rd Member's Name
First Name
Last Name
3rd Member's Date of Birth
-
Month
-
Day
Year
Date
4th Member's Name
First Name
Last Name
4th Member's Date of Birth
-
Month
-
Day
Year
Date
Parent's Contact Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent's Phone Number
Please enter a valid phone number.
Parent Name
First Name
Last Name
My Products
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AJRA 2023-2024 Membership
2023-2023 Membership
$
150.00
Choose One
Choose One
Price
Single Membership
0
1
$
150.00
Family Membership
0
1
$
225.00
Add On Family Member To PD Membership
0
1
$
0.00
Item subtotal:
$
0.00
1st Member's T- Shirt Size
$
Free
Shirt Size
Youth S
Youth M
Youth L
Small
Medium
Large
XLarge
2nd Member's T- Shirt Size
$
Free
Shirt Size
Youth S
Youth M
Youth L
Small
Medium
Large
XLarge
3rd Member's T- Shirt Size
$
Free
Shirt Size
Youth S
Youth M
Youth L
Small
Medium
Large
XLarge
4th Member's T- Shirt Size
$
Free
Shirt Size
Youth S
Youth M
Youth L
Small
Medium
Large
XLarge
1st Member's Birth Certificate
*
Browse Files
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of
1st Member's Social Security Card or W9
*
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of
2nd Member's Birth Certificate
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2nd Member's Social Security Card or W9
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of
3rd Member's Birth Certificate
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3rd Member's Social Security Card or W9
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of
4th Member's Birth Certificate
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of
4th Member's Social Security Card or W9
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of
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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the form.
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