Membership Application

Membership Application
Membership in the JA Staff Alumni Network is subject to approval by the JA Staff Alumni Network Executive Committee. Any former employee of Junior Achievement with 5 or more years of service to Junior Achievement is eligible for membership.
Provide your contact information
Name*

First NameLast Name
Nickname
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Would you like to receive text updates from the JA Staff Alumni Network.

YesNo
Can we post your contact information in a password protected, private JASAN member-only page on the JASAN website?*

YesNoOther/Limited Info Only
If "Other/Limited Info Only", please explain/let us know what info you would like posted.
What is the name of your spouse, partner or significant other?
Tell us about your JA experience
When were you hired by Junior Achievement?*

MonthDayYear
Date
When did you leave or retire from Junior Achievement?*

MonthDayYear
Date
What was the last JA area in which your worked?
Were you involved in Junior Achievement as a student? If so, tell us about your student experience. What years, what grades in school, what JA programs you were involved in and do you have favorite memories?
Tell us about your career experience with Junior Achievement. What positions did you hold? In what JA Areas did you work? Did you receive any awards?*
What are you doing at this point in your life?
Briefly tell us what you hope to get from your membership as a JA Staff Alumni Network member. Are there any specific goals you would like to achieve, committees you would like to become involved in, etc.?
May we have your permission to use your picture in our communications materials? At times, we may want to usea photo of you, either one you have submitted to us, or one taken at an event, to post on our website, or on our Facebook page, in our Newsletter, in our Membership Brochure, or any other communication piece being used by the JA Staff Alumni Network or JA USA.*

YesNo
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Membership Application

Provide your contact information

Tell us about your JA experience