Membership Application

Membership Level: First Name: Last Name: Email: Home Phone: Home Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip: - Zip Suffix With which gender do you currently identify? Which pronoun would you prefer? Parents: Parent Phone: Parent Email: Instrument: T Shirt Size: Birth Date: / / School: High School Graduation Year: Do You Take Private Lessons? If so, with Whom? Allergies: Dietary Restrictions: Medication and Instructions in Case of Emergency: When did you start playing music? What is your experience playing jazz, if any? How did you hear about CCJA? What are you biggest challenges with jazz? If you would like to be more specific about who or where you heard about us, please tell us here. We like to thank our family! What do you hope to experience from participating in CCJA?