Hinsdale Junior Woman's Club
Application for Associate Membership 2018-19
First Name
Your answer
Last Name *
Your answer
Email Address
Your answer
Spouse's Name if Married
Your answer
Street Address
Your answer
Town
Your answer
Zip Code
Your answer
Home Phone
ex. (630) xxx-xxxx
Your answer
Cell Phone
ex (630) xxx-xxxx
Your answer
Birthday
MM
/
DD
Year Joined HJWC
August 20xx
Your answer
Year Initiated HJWC
January 20xx
Your answer
Child 1 Name and Birthday (month/year)
separate multiple children's names by comma
Your answer
Child 2 Name and Birthday (month/year)
Your answer
Child 3 Name and Birthday (month/year)
Your answer
Child 4 Name and Birthday (month/year)
Your answer
Payments due: $40 + $2 convenience fee = $42 total per year
Associate Pre-Pay Details: We are offering Associates an opportunity to prepay your Associate Dues. You will continue to receive all your HJWC Benefits with no interruption and will occasionally be asked to verify information for the directory.

You may also prepay for a benefit ticket at discounted price of $150

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