SMYR Online Membership Form
SMYR Online Membership Form
Membership
*
New member
Renewing member
First name
*
Last name
*
Date of birth (00/00/0000)
*
Spouse first name (if joint membership)
Spouse last name
Spouse date of birth (if applicable)
Mailing Address
*
City
*
State
*
Zip
*
Cell Phone (000-000-0000)
*
Cell Carrier
*
Can You Receive Text Messages?
*
Yes
No
Alternate phone (000-000-0000)
Email
*
Spouse email (if applicable)
How did you hear about us?
Referral
Website
Other YR
Campaign
Areas of interest (Check all that apply)
*
Officer in YR's
Membership
Fundraising
Social
Communications
Website
Campaigns
Community Outreach
Annual Membership Dues
*
Individual: 25
Couple: $40
Student: $10
Associate Member (member of other YR chapter): $10
Honorary Member: $10
Chairman's Club Member: $100 Minimum Contribution
Today's date (00/00/0000)
*
PayPal name (email address) or Check number
*
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