2010-2011 Membership Application

*First Name:
Nickname :
*Last Name:
*Street Address:
*City:
*State:
*Zip Code:
*Home Telephone:
Work Telephone:
*E-mail Address:
Check if you prefer communication by email.
*Date of Birth:
Maiden Name (if applicable) :
Spouse's Name (if applicable):
*Do you have children?:
*Hometown/State:
The following information is used to place you into a small group of women with similar interests.
*College:
Graduate School and Degree:
Current Employer:
Current Position:
Family Members in the Junior League:
*Outside Interests or Hobbies:
*How did you hear about the Junior League?:
Tell us why you would like to become a member:
*Please notify The Junior League of Philadelphia, Inc. of any changes in the above information.
Please submit your dues payment of $200 by Monday, September 6, 2010 to: The Junior League of Philadelphia, Inc. 27 W. Lancaster Avenue Ardmore, PA 19003 Phone (610) 645-9696 *(Note: you may call to submit dues payment by credit card.)*