JMLBA Membership Form
Membership Year: July 1, 2017 to June 30, 2018

Use this form if you are a
*new member,
*renewing member, or
*current member who would like to update your contact information.

Please note this form has three parts: Contact Info, About You, and Membership Level.

You must click "Submit" at the end for us to receive your membership application.

PART 1. CONTACT INFO
First Name
Your answer
Last Name
Your answer
Organization
If you are a student, list your school. If you are in BLSA, list that as well, e.g. "Emory" or "Emory BLSA"
Your answer
Title/position
If you are a student, list your class year.
Your answer
Office Contact Information
We ask for both you office and personal contact information, but we will contact you via your preferred method. We will use the other information if we cannot reach you using your preferred contact information. This is helpful if you move, but forget to update your contact info with us.
Office Mailing Address
Street
Your answer
Office Mailing Address 2
Street 2 (unit #, etc.)
Your answer
Office City
Office State
Office Zip Code
Your answer
Office Email
Your answer
Office Phone Number
000-000-0000.
Your answer
Personal Contact Information
Home, etc.

We ask for both you office and personal contact information, but we will contact you via your preferred method. We will use the other information if we cannot reach you using your preferred contact information. This is helpful if you move or change jobs, but forget to update your contact info with us.

Mailing Address
Street
Your answer
Mailing Address 2
Street 2 (unit #, etc.)
Your answer
City
State
Zip Code
Your answer
Email
Your answer
Mobile Number
000-000-0000. Leave blank if you do not have, or do not wish to provide, a mobile phone number.
Your answer
Other Number
e.g. Home number. 000-000-0000. Leave blank if you do not have, or do not wish to provide, another phone number.
Your answer
Contact Preferences
Which is your preferred mailing address?
Which is your preferred email address?
Which is your preferred phone number?
Contact Opt-In
JMLBA sends a weekly e-newsletter and periodic emails related to JMLBA and other events and programming we believe would be of interest to JMLBA members and supporters. We may use a third-party, such as, but not limited to, Constant Contact, to send these email messages. In the past, everyone has wished to receive these emails.

JMLBA may send text reminders of our upcoming events. These will be infrequent reminders, e.g., on the day before or day of an upcoming JMLBA meeting or event. On occasion, we may send text reminders of non-JMLBA events, such as Election Day. We may use an auto-dialer or third-party to send these text messages. You are solely responsible for any charges associated with receiving these text messages.

You are not required to consent to emails or text messages as a condition of joining JMLBA or participating in JMLBA programs. By selecting "YES" below, you authorize JMLBA to deliver these types of messages using these methods to the email address and/or mobile number you provided herein.

Do you consent to receive email messages at your preferred email address listed above?
Do you consent to receive text messages at your mobile number listed above?
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