Join The Middletown Jaycees Today! First Name? * Last Name? * Date of Birth? * Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 12345678910111213141516171819202122232425262728293031 Street Address? * City/State/Zip? * Preferred Telephone Number: * Email: * What do you hope to obtain by your membership in the Jaycees? What special skills do you have? * How did you hear about the Jaycees? * How did you hear about the Jaycees? Who referred you to the Jaycees? What is your primary profession? Are you aware of the $50 membership fee? Yes No