Last Name__________________________ First Name_______________________
Address_________________________________________________________________
City_____________________________ State___________Zip_____________________
E-mail Address__________________________________________________________
Best Phone # (_____)________________
If a Family Plan – Members Names Relationship
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2024 Dues
Regular Member ………………………… $15.00 __________
Family Plan ………………………..….… $25.00 __________ (Regular Plus Unlimited Family Members)
Junior Member ….……………….… $10.00 __________ (17 & under)
Senior Member …………………….……. $ 8.00 __________ (Over 65 after 1st year as Regular Member)
Total Amount Enclosed $__________
Make checks payable to SJMDC and mail to:
SJMDC Membership – PO Box 365 – Port Norris, NJ 08349
Visit our website at www.SJMDC.org for information on meeting times, etc.