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Hinsdale Junior Woman's Club
Application for New Membership 2017-18
First Name
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Last Name
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Email Address
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Cell Phone
ex. (630) xxx-xxxx
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Full Street Address
ex. 1234 Walnut Street
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Town
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Zip Code
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Birthday
MM
/
DD
Spouse's Name
Your answer
Child 1 Name and Birthday (month/year)
ex. Jane 6/2010
Your answer
Child 2 Name and Birthday (month/year)
ex. Jane 6/2010
Your answer
Child 3 Name and Birthday (month/year)
ex. Jane 6/2010
Your answer
Child 4 Name and Birthday (month/year)
ex. Jane 6/2010
Your answer
Committee Selection
Please indicate your 1st choice
Committee Selection
Please indicate your 2nd choice
Committee Selection
Please indicate your 3rd choice
How did you hear about Hinsdale Junior Woman's Club? (friend, media, fundraiser, etc)
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Do you have a friend already in the club or that is also joining the club this year?
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Are you a member of other clubs, organizations and/or associations? What is your involvement?
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What experience or interests do you have that may be helpful to a club committee?
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Are you a business owner or would like to share your professional information for networking purposes? This information will not be distributed outside of club members. Feel free to complete as much information as you wish. (optional)
Member Occupation:
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Company:
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Professional Email:
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Website:
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Skills/Products/Services Offered:
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Significant Other Occupation:
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Company:
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Professional Email:
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Website:
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Skills/Products/Services Offered:
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Payments due: $275 total

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