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Alumni
Supporter Recognition
Bowl-A-Thon
Annual Leadership Awards Gala
Aim For Success
Annual Golf Events
Corporate Stock Market Challenge
ALUMNI REGISTRATION FORM
W
elcome to the registration page for Junior Achievement of New York Alumni Network. If you are a JA alumni currently residing in NYC or Long Island, or if you are a former JA New York student, please take a moment to fill out the form below.
Please make sure to fill out all required fields. All other fields are optional.
Required fields are marked by a (
*
).
PROFESSIONAL INFORMATION
*
Salutation:
Mr.
Ms.
Mrs.
Miss.
*
First Name:
*
Last Name:
*
Company:
*
Address:
Floor/Suite:
*
City:
*
State:
--Select--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Dakota
South Carolina
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip:
Work Phone:
Work Fax:
Work E-mail:
PERSONAL INFORMATION
Home Address:
Apt:
City:
State:
--Select--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Dakota
South Carolina
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
*
Home/Cell Phone:
*
Home E-mail:
Where did you attend college?
What was your major?
Year of graduation
ABOUT ME:
In what grade(s) did you receive JA Programs?
K-2
3-5
6-9
9-12
Which JA programs did you participate in?
JA Company Program
High School Heroes
Student Ambassador
Not Sure
Other
If Other please specify :
Would you be interested in attending JA Alumni networking or business events?
Yes
No
Are you interested in volunteer opportunities with JANY
Yes
No
Would you be interested in receiving JANY e-mail updates and electronic JANY newsletter
Yes
No
ALUMNI HISTORY:
Please list current membership in other social or professional groups, organizations and societies:
Please list other non-profit organizations where you serve as a board member or volunteer.
List special interests and pursuits:
List professional honors and awards:
Please send JANY communications to my home e-mail address
Please send JANY communications to my business e-mail address