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Crew Update

Crew Yahoo

 

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

Kim will submit your update with the next site update.

PLEASE NOTE IF YOU DO NOT HAVE INFORMATION FOR A QUESTION JUST ENTER NONE!

Personal  


First Name:


Last Name:
Address:

Additional Address:

City:
State:
Postal Code:
Country:

Spouse:

Home Phone:

Include area code!

Cell:

Professional  

Business:


If retired enter last place of business, title and enter (retired)
Job Title:
Business Phone:
Include area code!
Business Phone Ext:
Include area code!
Fax:
Include area code!
Email
Web Site:

Full address such as
http://treasurebug.com/usa 
Jaycees  
Year Joined Jaycees:

JCI Senate #:

Home State:

Last Jaycee Office Year:

Last Jaycee Office: