NCJW · New Lifetime Membership Form For Those Submitting Checks

Contact Information

Name

First Name

Last Name

Email

Verify Email

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Phone

My phone number is:

Phone number type:

Home

Cell

If this is a gift membership, please send an email to the NCJW office (ncjwofkc@gmail.com) with the new member contact information. You can skip the rest of the questions. A seperate email will be sent to the new member to gather their information. Please check "I am not a robot", and click on submit. Please make your $360.00 check payable to NCJW, and mail to the NCJW office at 5311 W. 75th St., Prairie Village, Kansas 66208.

Birthdate - This will not be shared outside of NCJW.

(mm/dd/yyyy)

Preferred Mode of Contact

Additional skills or interests (Social Media, Tech Support, Marketing, etc.):

I have small children, and I would be interested in family programs.

Yes

No

What prompted you to join NCJW?

Do you have additional comments or questions?

Do you know someone else that might like to join? Please provide their name, email, and phone number so we can reach out to them.

Send check to:

Please make your $360.00 check payable to NCJW, and mail to the NCJW office at 5311 W. 75th St., Prairie Village, Kansas 66208.