Join the PRJC

Please fill in this form, print and send with a check for your membership request to the address listed above

Title:   Mr Mrs Miss

First name:
Last name:
Street Address:
City:
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Zip:

Phone number:  

Email:   

Couple's 2nd Email:   

Annual dues:  Individual - $30    Couple - $45    Sustaining - $75    Premier - $150

       Annual Dues amount:

       Contribution to the Youth Learning Program (YPL):

 Total Amount:

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