CROWN CLUB 2020-2021 MEMBERSHIP APPLICATION
JUNIOR AUXILIARY OF MADISON COUNTY 9th-12th GRADE GIRLS
Email address *
First Name
Last Name
Past Crown Club Member
If yes, what year did you participate?
Address
City
State
Zip Code
Cell Phone
Grade Level (2020-2021 School Year)
Please confirm email address - Be sure to verify what you enter!! This is how we will communicate with you!!!
Tshirt Size
School
Birthday
MM
/
DD
/
YYYY
Mother's/Guardian's Name
Mother's/ Guardian's Cell Phone #
Mother's / Guardian's Email Address - Be sure to double check this to make sure that it is correct!!!
School Honors and Activities
Community Volunteer Work
Is any member of your family an Active, Associate, or Life member of Junior Auxiliary?
If a member of your family is an Active, Associate, or Life member of Junior Auxiliary please list their name
In case of emergency, who should Crown Club contact?
Emergency Contact - Telephone Number
Please list name of family physician
Family Physician's Telephone Number
Is there any medical condition that Crown Club should be aware of?
Clear selection
If so, please explain.
Do you have any allergies that Crown Club should be aware of?
Clear selection
If yes, please explain.
We look forward to a fun year together!
Be sure to click SUBMIT prior to leaving this page! Otherwise, we will not receive your information!!!!!!

Crown Club Dues are $50 - and will be due prior to receiving your 2020 - 2021 Crown Club t-shirt. All dues must be paid in full by November 1.

You may pay in full - or make smaller monthly installments if you would like.

You may pay online via Paypal - jamccrownclub@gmail.com - or mail a check made payable to JAMC Crown Club to 125 Belle Pointe; Madison, MS 39110.

By submitting your online application, you agree to the Crown Club Code of Conduct and Policy and Procedures.

https://jamccrownclub.org/policies-and-procedures

If you have any questions, please contact me at jamccrownclub@Gmail.com - or text me at 6018627371.

Thanks,
Pam Ware
A copy of your responses will be emailed to the address you provided.
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