Name *

First Name

Last Name

Phone

(###)

###

####

Committees of Interest *

Select all that apply.

Senior's Committee

Events Committee

Community Liaison

Finance Committee

Young Adults Committee

Benevolence Committee

Are you Jamaican or of Jamaican descent? *

Yes

No

By acknowledging below, you agree that all information you have provided in this application is true to the best of your knowledge. *

This section serves as your digital signature.

Yes, I agree

No, I do not agree

Date *

MM

DD

YYYY