Membership Application Please Complete & Print National Council of Jewish Women Greater Detroit Section 26400 Lahser Road, Suite 306 Southfield, MI 48033-2675 Date:                                New Member                Current Member Last Name:                                           First Name:                                           Title:     Dr. Mrs. Ms. Mr. Spouse's Name: Address:                                               City:                                                   State:        Zip:       AK AL AR AZ CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY     Phone:                          Email:      Occupation:                                                                                          Date of Birth:     Who referred you to NCJW/GDS?: Seasonal Information: Dates Away:         From:      Returning: Address:                                               City:                                                     State:       Zip:        AK AL AR AZ CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    Phone:                        Involvement in other organizations:    Payment Information: Annual Membership $50.00    Life Member - full payment $350.00    Life Member - partial payment $175.00 GROW Teen Member $18.00    Payment Method:   Cash (do not mail)    Check        Visa       Mastercard Check#: Acct No: Exp: Signature:_________________________________________________________________________________________________ Make Checks payable to NCJW/GDS MAIL FORM AND PAYMENT TO: NATIONAL COUNCIL OF JEWISH WOMEN, GREATER DETROIT SECTION 26400 Lahser Road, Suite 306 Southfield, Michigan 48033-2675 To charge by phone (Visa and MasterCard only) call NCJW/GDS at 248-355-3300, ext. 0 To pay online, use our Online Membership Process