Directions: Fill out this form online. After completing it, use your browser's print command to print the finished form. Sign and mail with check or money order ($36 regular, $18 full-time students and seniors) for first year dues to: JDL, P.O. Box 480370, Los Angeles, CA 90048.

Last Name First

Middle Email address

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Permanent address Mailing address

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Telephone (please include area codes)

home work

pager cell

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Date of birth (mm/dd/year) Occupation

Previously pay for membership? Yes, by check or by PayPal Wish to start a chapter if there isn't one in the area?

Briefly describe talents and abilities you would like to offer to JDL:

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I hereby apply for membership in the JEWISH DEFENSE LEAGUE.
I have read and agree to the terms of JDL's Membership and Privacy Agreement.

Date Signed ___________________________________