Membership Application Form (** Required Field) Member Types Regular $1,650 Associate $950 Individual $950 **Your Name: **Your Title: **Your E-mail: Company Information **Company Name: **Address1: Address 2: **Address 3: City: State: Zip: **Company Phone: **Company Fax: Company E-Mail: Company Homepage: Chief Representative Information **Chief Rep. Name: First: Middle: Last: **Chief Rep. Title: **Chief Rep. Phone: Chief Rep. Fax: **Chief Rep. E-mail: Secretary Name: Secretary Phone: Secretary Fax: Secretary E-mail: Contact Person Information **Contact Name: First: Middle: Last: **Contact Title: **Contact Phone: Contact Fax: **Contact E-mail: Additional Information **Company Profile: # Of Employees: Comments: We don't accept credit cards. Please remit membership dues to JCCI. We are sorry about this inconvenience.