NEW MEMBER APPLICATION FORM

Thank you for your interest in becoming a new member of the JA Staff Alumni Network!

We have a few questions for you and hope you will provide some background information about your experience with JA, what you're doing now and your expectations regarding your membership in the JA Staff Alumni Network (JASAN).

The mission of the JA Staff Alumni Network is to provide a network for staff alumni and to further the mission of JA USA.

Contact Information

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* 1. Address

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Can we have your permission to post your contact information in a password protected page on our website?

Yes, I agree to your posting my contact information in a password protected page on the JASAN website.

No, I do not want my contact information posted on the JASAN website.

Yes, but I only want the following contact information posted on the JASAN website:

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* 3. Is your phone number a cell phone?

Yes

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* 4. If it was not a cell phone number, would you be willing to provide one?

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* 5. Can the JA Staff Alumni Network occasionally send you a text message?

Yes

Comment

Background Information

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* 6. Were you a Junior Achievement Student Participant?

Yes (I want to just move forward with the Staff Alumni Network Membership Application at this time.)

Yes ( I want to register with the Connect Alumni Campaign now by going to that site in a new tab on my browser) - click here to do so > LINK [you won't be leaving this form, just opening a new tab.]

No (I was not involved with Junior Achievement as a youth)

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* 7. In what areas or cities did you serve and in what positions?

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* 8. When were you hired by Junior Achievement?

Date

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* 9. When did you leave or retire from your employment with Junior Achievement?

Date

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* 10. What is the name of your spouse or partner? (If you do not have one at present, just indicate "n/a".

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* 11. Provide a brief summary of your JA Background, along with your contributions to the organization. Include the positions you held, awards and honors you received, programs you launched, etc.

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* 12. What are you doing now? (Describe your current activities.)

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* 13. 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.?

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* 14. May we have your permission to use your picture in our communications materials? At times, we may want to use a 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.

Yes

Yes, but with limits (Please clarify by adding a comment)

Comment for clarification:

Thank you.

Thank you for providing this information. We appreciate your interest in the JA Staff Alumni Network and we will be back in touch with you soon.

Visit our website to meet the JA Staff Alumni Network Executive Committee.

Sincerely,
Tami Godsey, Membership Chair

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