Contact Information
Membership Information
Payment Information
Contact Information
First Name
*
Last Name
*
Email
*
Phone
*
Membership Information
Membership Type
Quantity
Amount
Total
JWC Member
85.00
JWC Annual Partner
136.00
JWC Single Event
25.00
Total
Registration Amount
*
Please consider helping with a donation.
Select Amount
$25 - Sponsor a friend for an event
$85 - Sponsor membership for a friend
$100 - Event Co-sponsor
Other
Total Amount
*
Would you like to volunteer? Any comments?
Payment Information
Card Number
*
Card Expiration
Month
1 - January
2 - February
3 - March
4 - April
5 - May
6 - June
7 - July
8 - August
9 - September
10 - October
11 - November
12 - December
*
Year
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
*
Security Code
*
Name on Card
*
Billing Address
*
Zip Code
*
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