Full Name:
 
Were you ever a JOOI Member?  
Are you currently a full-time college student?  
 
Home Address
Street:
City: Zip:
Home Phone:    
Home Fax:    
Email Address:    
 
Business Address
Firm Name:    
Type of Business:    
Street:
City: Zip:
Business Phone:    
Business Fax:    
Business Email:    
Business Position or Title:    
May we contact you at work?:    
Sponsor's Name:    
Optimist Club of    
 
Individuals who have committed sexual offenses against children may be denied membership and/or have their membership revoked.