St. Peters Jaycees Membership Application

First Name:    Last Name: 

Street Address: 

City:    State:    Zip: 

Home Phone:    Cell Phone: 

Email Address: 

Referred By: 

Do you have any friends or family who you think would be interested in

joining the St. Peters Jaycees? 

We are looking for people who share our vision of improving the community.

If you know anyone like this, please feel free to fill out the referral below and we will be happy to provide them with further information.

Name:     Home Phone: 

Address: 

Name:     Home Phone: 

Address: 

The cost of membership is $55.00 per year.

If application submitted on-line, dues can be mailed to:

St. Peters Jaycees Membership, P.O. Box 237, St. Peters, MO 63376