YDSJ Membership Form
First Name *
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Middle Name
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Last Name *
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Birthday *
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Residential Address *
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City *
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State
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Zip Code *
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Preferred Email Address *
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Preferred Phone Number *
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If known, please provide your: Supervisorial District
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Assembly District
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Senate District
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Congressional District
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Occupation
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Employer
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Please share your skills and experience.
Please share your interests.
Comments
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