Join JYDA - Membership Application

Instructions:
You can print and fill out the JYDA membership application in Adobe .pdf format. Click here for the .pdf application. Please note: make sure to send the completed application with your check for $50 made out to JYDA (American currency only) to:

JYDA
c/o Adam Kofinas
820 2nd Avenue
10th Floor
NY, NY 10017

If your computer does not support Adobe .pdf documents, you can fill out the form below and then print this page. As noted above, please send the completed application with your check for $50 made out to JYDA (American currency only) to:

I am a:

New member of JYDA
Returning member of JYDA

Name: Birthdate:

Home Phone:

Mailing Address:

City/Province/State/Zip/Postal Code:

Work Phone: Work Fax:

E-mail Address:

AIM Screenname:

Male Female

Congregation/Agency of Employment:

Position Title:

Region affiliated with:

Full-time Youth Professional Part-time Youth Professional

Size of Congregation/Agency:

I would like to be:

A Mentor
Mentored

I am able to assist in the following areas (check all that apply):

General Programming
Fundraising
Educational
Social Action
Religious
Leadership Training
Membership Outreach
Israel
Other