JUG NATION JEWELS YOUTH DEVELOPMENT PROGRAM
PO BOX 38205/PHOENIX, AZ 85069-8205
Tax ID # 47-2807870
Membership Registration Application
J.U.G. (Jus Us Girls) Nation Jewels Youth Program is a 501(C) (3) nonprofit sisterhood based
mentoring program in Phoenix, Arizona for young girls, ages 12-18 years old designed to
Inspire, Educate and Equip them with life skills, leadership training and resources to increase their
ability to succeed after high school. Our program helps to foster the Jewels with strength of
Character, respect toward others and the community, affirmative behavior and most importantly, a
positive environment that promotes a bond of sisterhood, love and respect toward one another.
Full Mailing Address
Date of Birth
Parent/Guardian Name (First/Last)
Home Phone (if any):
Do you work?
If so where/ what title?
What are your hobbies?
What are your plans after high school?
What would you like gain from being in the Jewels Program?
Are you willing to commit the time needed to become your best self & prepare for your future?
How did you hear about our program?
If other (Explain).
If referred by a Jewels member, please list their name here:
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