DEVELOPING LEADERS FOR A CHANGING WORLD

Membership Application Form

□ Yes, I am between the age of 18 to 40 and I want to be a Passport
member of JCI. Size

OFFICE USE
ONLY Name of the
Chapter: Phot
Application # o
Application Date:

Name:
Gender: □ Male□ Female Date of birth: dd / mm / yyyy Blood Group:
Company Name:
Job Title:
Work Address:
Phone:
Fax: Email:
URL:
Business Classification: (Please check the box according to your business type)
□ Accounting/ Auditing □ Advertising / Promotion □ Construction / Engineering / Building □
Supply/ Renovation
□ Cafe/ Restaurant / Hotel □ Entertainment □ Education/ Educational Supply □ Finance/ Banking/
Exchange□
Manufacturer □ Government / Civil Servant □InformationTechnology □ Medical / Laboratory
□Trading □
Service/ Insurance□ Legal □ Travel/ Transportation □Other(pleasespecify)

Education Qualification:
Home Address:
Phone: Fax:
Mobile:
Marital Status: □ Single □ Married Wedding Anniversary:

Introduced by
Applicant

Name, Signature & Date Signature

& Date
Personal Interest Information: (Please check the box according to
your interest) Individual Area of Opportunity
□ Personal Development □ Meetings
□ Trainer □ Training
□ Membership Growth & Extension

Community Area of Opportunity

JCI Major Emphasis Community Development
Theme
Children & Youth
Economic Affairs
Governmental & Civil
Affairs

International Affairs & Chapter Twinning

Relations
Awards
JCI Meeting

Finance Records
Strategic Marketing & Public Relations
Planning
Chamber of Commerce Partnership
Business
Affairs

MembershipApprovalByLocalOrganizatio Membership Approval By NGB

n

Signature & Signature & Date

Date

Membership ID #

MEMBERSHIP PROCEDURE

Fill-up the Membership Application Form with one copy of passport size photo
Provide a copy of your National ID Card
Submit your Membership Application Form to the Chapter’s Secretary General
Attend at least one General Membership Meeting (GMM)
After getting the approval from the Chapter membership Development Committee your membership
Application Form will be forwarded to National Executive Committee for further Approval