1501 Avocado Ave., Suite 2 Melbourne, FL 32935
Office (321) 610-8950 Fax (321) 622-2728
MEMBERSHIP APPLICATION
ALL INFORMATION IS STRICTLY CONFIDENTIAL
NAME: _______________________________________________________________________________
(LAST) (FIRST) (MIDDLE) (MAIDEN)
ADDRESS: ____________________________________________________________________________
(STREET) (CITY) (STATE) (ZIP)
CELL PHONE: _______________ HOME PHONE:_________________ WORK PHONE: ________________
EMAIL ADDRESS: ___________________ Are you on Facebook? YES NO
DATE OF BIRTH: ___________________ SPOUSE’S NAME: _______________________________
PREFERRED METHOD OF COMMUNICATION: _______________________________________________
(Email, phone call, text)
NAME AS YOU WISH IT TO APPEAR ON YOUR NAME TAG: _____________________________________
EDUCATION: High School or College(s) attended: Degree(s) Year
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Extracurricular activities and awards: _____________________________________________________
Post graduate training course or additional education: ________________________________________
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Employment Experience: Employer Type of Work Date
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Volunteer Experience:
Organization Type of Work Date
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What was your most meaningful volunteer experience? _______________________________________
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Special skills, interests and abilities (ex. 2nd language, computer skills, artistic talents, photography, websites, public relations, etc.)
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What do you feel you can contribute to the JLSB? ____________________________________________
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What do you feel is south Brevard’s greatest community need at this time?
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Were you referred to the JLSB by a member? Yes ___ No ___ If so, by whom? ____________________
Do you understand the financial and time obligations?(ex. Dues, meetings, fundraisers, etc.)Yes ____No____
If you have any other membership questions, please call our office (321) 610-8950 or email us at
. Thank you for your interest in the Junior League of South Brevard, Inc. Please return your application to JLSB office at 1501 Avocado Ave., Suite 2, Melbourne, FL 32935 or email it to membership at
I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE.
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Candidate’s Signature Date
JLSB New Member dues of $160 must be paid by the 2nd Learning Session in October. Payment plans available as needed.
The Junior League of South Brevard, Inc. is an organization of women committed to promoting voluntarism, developing the potential of women and improving the community through effective action and leadership of trained volunteers. The purpose of the Junior League is exclusively educational and charitable.
JLSB Impact Statement: Improving Children's Health Through Nutrition and Physical Activity
Revised August 2017 JLSB, Inc. Proprietary Page 2