WorkshopJAX Membership Application Form

Association Membership Application Form
Name

First NameLast Name
Date of birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Membership Type:

Individual MembershipRestricted MembershipStudent MembershipOther
Email
example@example.com
Phone Number
Please enter a valid phone number.
Payment Information:
Payment Method

Credit CardCheckCash
Please indicate the benefits you are interested in:

Access to WorkshopJAX off hoursExclusive room access*Discounts on products or servicesSubscription to newsletters or publicationsVolunteer opportunitiesOther
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Information:
How did you hear about us?
Why are you interested in joining WorkshopJAX?
Do you have any special skills or interests you would like to contribute as a member?
Any other comments or questions?
Declaration:

I certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that membership approval is at the discretion of the association and may be subject to review.
Signature

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Date

MonthDayYear
Date
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Association Membership Application Form