Member Application

Complete the membership application form below, then click the Send button. Your application will be forwarded to the Membership Committee for action. If you prefer, you can download a PDF version of the JCSE-VA Membership Application Form to submit via mail.

First Name*

Middle Initial

Last Name*


Email Address*

All information releasable? YesNo

Mailing Address




Postal Code

Home Phone

Business Phone

Membership Type: Standard - $25/two yearsLife - $200Reinstatement - $29

T-Shirt Size: SML1X2X

Golf Shirt Size: SML1X2X

JCSE Duty Assignments

<------ Click to submit your application!

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Dues can be paid online or by check.
After submitting your application form, visit the Pay Dues Online page to make any online payment or for information on paying by check.