NJC Membership Update
Please complete the form below:
Title
*
Mr.
Ms.
Mrs.
First Name
*
Middle Name
*
Last Name
*
Address
*
City
*
Zip / Postal
*
State / Province
*
- - Choose One - -
- - US States - -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
- - Canada Provinces - -
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
Email Address
*
Cell Number
Home Number
Tribe Name
*
Reuben
Gad
Zebulun
Simeon
Issachar
Levi
Naphtali
Judah
Asher
Dan
Joseph-Manassas
Benjamin
Joseph-Ephraim
//Not In A Tribe//
Title
*
Mr.
Ms.
Mrs.
Spouse First Name
Spouse Middle Name
Spouse Last Name
Child First Name - Under 18
Child Middle Name - Under 18
Child Last Name - Under 18
Gender
M
F
Child First Name - Under 18
Child Middle Name - Under 18
Child Last Name - Under 18
Gender
M
F
Child First Name - Under 18
Child Middle Name - Under 18
Child Last Name - Under 18
Gender
M
F
Child First Name - Under 18
Child Middle Name - Under 18
Child Last Name - Under 18
Gender
M
F
Child First Name - Under 18
Child Middle Name - Under 18
Child Last Name - Under 18
Gender
M
F
How long have you been a member of NJC?
Under 6 Months
6 Months
1 Yr
1 Yr - 3 Yrs
3 Yrs - 5 Yrs
5 Yrs - 10 Yrs
Over 10 yrs