AJRA Online Membership Form

AJRA Online Membership Form
1st Member's Name*

First NameLast Name
1st Member's Date of Birth*

MonthDayYear
Date
2nd Member's Name

First NameLast Name
2nd Member's Date of Birth

MonthDayYear
Date
3rd Member's Name

First NameLast Name
3rd Member's Date of Birth

MonthDayYear
Date
4th Member's Name

First NameLast Name
4th Member's Date of Birth

MonthDayYear
Date
Parent's Contact Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Phone Number
Please enter a valid phone number.
Parent Name

First NameLast Name
1st Member's Birth Certificate*

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1st Member's Social Security Card or W9*

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2nd Member's Birth Certificate

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2nd Member's Social Security Card or W9

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3rd Member's Birth Certificate

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3rd Member's Social Security Card or W9

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4th Member's Birth Certificate

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4th Member's Social Security Card or W9

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My Products

AJRA 2024-2025 Membership Product Image

AJRA 2024-2025 Membership2024-2025 Membership

$100.00

Choose One	Choose One	Price
Single Membership		$100.00
Family Membership		$150.00
Add On Family Member To PD Membership		$0.00

Item subtotal:$0.00

1st Member's T- Shirt Size

$ Free Shirt Size

3rd Member's T- Shirt Size

$ Free Shirt Size

2nd Member's T- Shirt Size

$ Free Shirt Size

4th Member's T- Shirt Size

$ Free Shirt Size

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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