Membership form online

Application Type  New Membership Renewal

Applicant Information

Given Name
Middle Initial
Unit / Suite #
Postal Code
Home Phone #
Cell Phone #
Work Phone
Email Address*
Do you give JCA consent to send you updates
and messages by phone and/or e-mail?
 Yes No
Preferred Method of Contact
 Home Cell Work E-mail
Membership Dues
Annual Membership Fees
(due April 1st of each Year)
Individual: $30.00 | Family: $50.00 | Youth & Seniors: $15.00

Membership Type
 Adult Youth / Student(16-24) Senior(65+) Family (two adults plus children under 16) Please provide names of all family members below:
Full Name (last, first)
 Corporate(please contact us for rate)
Corporation / Entity
Applicant’s Title
Method of Payment
 Cash Cheque
Credit card
 Visa MasterCard American Express
Cardholder Name
Credit Card #
Expiry Date (mm/yy)
Please confirm and specify how you authorize us to
charge your card pursuant to the fees listed above
 One Time Charge Yearly Recurring
How did you find out about the Jamaican Canadian Association?
 Newspaper Friend Relative Event Social Media Radio Other Current Member
Special Interests / Comments
The Jamaican Canadian Association is a member driven organization. We encourage and rely on all members to become active participants and volunteer on our committees.Please indicate your Committee of Interest (check all that apply):
Please specify any additional skills or interests you would like to share with the JCA: