Membership Application

If you are having difficulty with the online form, a printable version is available here.

Membership Application Type *New MembershipRenewing MembershipGift Membership

Member ID# (Optional)

Contact Information ChangePlease check if any of your contact information has recently changed

Recipient's Information

First Name *

Last Name *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Country

Phone *

Email Address

Gifter's Information

Gifter First Name *

Gifter Last Name *

Gifter Street Address *

Gifter City *

Gifter State/Province *

Gifter ZIP/Postal Code *

Gifter Country

Phone *

Email Address

Please check here if you (the Member) will be 70+ by October 2024We celebrate our 70+ seniors each year at our Keiro Kai event

Membership Level(s) *$65 - Individual$110 - Couple/Family$35 - Senior Individual (65+)$55 - Senior Couple (65+)$35 - Assistance* Individual$55 - Assistance* Couple$10 - Assistance* Senior (65+) Individual$20 - Assistance* Senior (65+) Couple$30 - Student/Youth$200 - 1000 Club$3000 - 1000 Club Life$32 - 1000 Club Spouse$22 - Monthly Printed Copy of Pacific Citizen

The membership includes a free email subscription to Pacific Citizens. If you prefer to receive a printed copy of Pacific Citizen instead, you can do so for an additional $22 per year. Please check above if you request to receive a printed copy monthly.

*Assistance discounts are available for a maximum of two years.

Total

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515 Petaluma Ave
Sebastopol, CA 95472

707-861-3487
info@sonomacountyjacl.org