THE NAPLES JUNIOR CHAMBER - JAYCEES

Member's Name:

Member's Birth Date:

Is spouse also a member? Yes No

Would you consider asking your spouse to belong? Yes No

Home Phone:

Would child care be important to have at meetings? Yes No

Children's names and birth dates:

Spouse's Name:

Spouse's Birth Date:

Would you consider asking your spouse to belong? Yes No

Member Occupation Title:

Do you own/manage your own business? Yes No

Employer/Supervisor's Name:

Work Address:

Work Phone:

Accept calls at work? Yes No

Employer's Attitude Toward the Junior Chamber?

Spouse's Occupation Title:

Do you own/manage your own business? Yes No

Employer/Supervisor's Name:

Work Address

Work Phone

Accept calls at work? Yes No

Employer's Attitude Toward the Junior Chamber?

Are you involved in businesses outside of your regular employment? Yes No

Is so, what businesses?

Current Affiliations with Other Organizations:

Past Personal Achievements/Awards you have received and/or past Leadership experiences:

Church & other activities: Hobbies:

Special Skills

Please check items that you own/or have approved access to:

IBM compatible computer

MS Word - WordPerfect - Laser Printer - FAX modem - FAX machine - Copier - Car Phone

Other computer equipment/programs:

Member/Spouse's reason for joining:

Date joined the Junior Chamber: Sponsored/referred by:

How did you find out about the organization?:

Do you desire to serve in a leadership position? Yes No

Any particular area?:

Areas of interest:

1. Do you feel the day, time and place of our meetings is satisfactory? Yes No

If no, what would you suggest?

When

Where

2. Do you know the chapter officers and directors? Yes No

3. Do you feel this is a friendly organization? Yes No

4. Have you attended an orientation? Yes No

5. What would you change about your organization?

6. What programs/projects do we need to conduct in our community?

Short term goal (0-5 years):

Long term goal (5-10 years):

7. What projects interest you the most?

8. Is there a project that we conduct now that you feel should be dropped? (Name)

9. Is there a project that we don't conduct now that you would like to see us start? (Name)

10. How can we better service the community?

11.How can we better serve you?

12. Who are three (3) people you would recommend to join the organization?

a. Name Address

Home Phone

Work Phone

Accept calls at work? Yes No

b. Name

Address

Home Phone

Work Phone

Accept calls at work? Yes No

c. Name

Address

Home Phone

Work Phone

Accept calls at work? Yes No