Online Membership Form Online Membership Form Membership Information Membership Type: I am a Professional Educator and/or Performer (Registration fee = $45) I am a Middle School, High School, or College Student (Registration fee = $25) Personal Information Name: Home Address: City: State: -- AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip: Work/School Information School/Work Name: Your Title: Address: City: State: -- AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip: Contact Information Preferred E-mail Address: Personal Phone: Work Phone: Other Information In which of the following areas of jazz are you involved? Performance Education Industry Elementary School Middle School High School College/Univ. MS/HS Student College Student What services and/or resources would you like IJEA to offer its members? To create your IJEA Member Login, please choose a password and verify it below. The password must have at least 6 characters and 1 number. Password: Verify Password:
