Illinois Juvenile Officers Association
Membership Application
I am requesting membership in the Illinois Juvenile Officers Association for one year. I understand that my membership fee is $5.00.
New
Renewal
Title:
First Name:
Middle Initial:
Last Name:
Employer:
Employer Address:
City, State, Zip:
,
Home Address:
City, State, Zip:
,
Phone Number:
Home Phone
Work Phone
Fax Number:
Home Fax
Work Fax
Email Address:
Send Mail To:
Home
Work
Are you a member of an ILJOA Affiliate Association?
Yes
No
Affiliate Association:
Please print and send completed application and check for $5.00 for one year's due to:
Illinois Juvenile Officers Association
Robert Stegenga, Executive Director
16220 Wausau
South Holland, IL 60473
708-210-2951
Thank you for your interest!