CREW LISTING?

Complete the form below and it will be submitted to Kim Newlin jcisenator@msn.com and he will update your record.

Last Name:
First Name:
Full Proper Name Including Initials:
Address:
City:
State/Province:
Postal Code:
Country:
Business:	If retired enter last place of business, title and enter (retired).
Job Title:
Home Phone:	Include area code!
Business Phone:	Include area code!   Extension
Cell Phone:	Include area code!
Fax:	Include area code!
Email Address
Web Site Address:	If one! Such as: http://www.websiteassist.com
JCI Senate #:
Spouse:
Highest Jaycee Office Held:
Years:
Home Chapter:
Home State:
Birthday:	i.e.: 01/01/1954
Anniversary:	i.e.: 01/01/1954
Date Joined Jaycees:	i.e.: 01/01/1954
Recruiter: