000 Formidable Forms Test Jacksonville Camera Club Membership Application with Payment Please complete this form to register as a club member. First Name * If you wish to include initials please add them to the First Name field Last Name * Date Submitted Birthday (Month – Day) Email Address * Phone No. Primary * Phone No. Secondary Address * City * State * Zip * Professional Level Main Income Source Part of Income Ocassionally Virtually Never take Paid Assignments Do you take paid assignments? Experience Level High Level Medium Level Novice None, I just like photographers Interest Beyond Photography Recommended or Refered by: Any Comments you choose to make Annual Dues * Single Membership: $40.00 Annual Family Membership: $60.00 Annual Membership dues cover the first 12 months of membership. Family Membership includes the Single Member, plus one additional Family Member living in the same household. Additional Family Member Name * Additional Family Member Email Address * Additional Family Member Phone No. * Annual Dues Payment Options * Pay Via Secure Credit Card - Preferred as the contact-less payment option Pay In Person At Next Club Meeting Total Payment Due Credit Card If you are human, leave this field blank. Δ
