Mens Club Membership Registration

Mens Club Membership Registration

Enter your details to register for membership.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Tell us about your interests or skills
Membership Dues

Membership begins July 1st and ends June 30th of the following calendar year. Regular Membership: $45. Senior Membership: $36. Payment can be made by check and mailed to: NSJC Men's Club 385 Old Town Road, Port Jefferson Station, NY 11776 or by credit card by clicking on the zeffy link in this email. Deadline for registration is 8/25/26.
I will be attending the Membership Barbeque on 8/30 and am enclosing an additional payment of $10.00
Amount Paid
Method of Payment
Are you interested in volunteering for club events or serving on a committee?
Should be Empty:

Membership Dues