JCRSEA Membership Form

2012-2013 School Year
Local Dues is $20.00/year
This includes the cost of mailing the directory to you.
Print this page, fill it out, and mail it to Jackie Preston.

Please Print

Name: 

Home Phone: 

Cell Phone: 

Address: 

City:                                                                               State:

Zip:                                                              Year Retired:

E-mail Address: 

Do you prefer we send your newsletter by e-mail? ___Yes   ___No

Do you prefer to be contacted by email for the luncheons? ___Yes   ___No

Please make check payable to JCRSEA

Please return this form with your check to:

Jackie Preston
489 S. Fig Way
Lakewood, CO 80228-2323