Membership Profile & Interest Survey

Please take a moment and complete our survey. This will help us tailor programs and volunteer opportunities to fit our members’ interests and needs.

Name:        
Address:     
City:              State:       Zip Code:
Home Phone:     Work Phone: 
Best Time of Day to Contact You:  Morning Afternoon Early Evening Night (not after 9PM)
Email:        
Occupation:
Name of Partner/Spouse (optional):
Number of Children (optional): 0 1 2 3 4 5 6

Yes No   May we list your name and information in our membership roster?
Yes No   Would you like to be added to the State Political Action EList?
Yes No   We will be creating a Section Elist for the purpose of sending information about upcoming events and activities, as well as volunteer opportunities.  May we include you on this Elist?  (this is separate and different from the State Political Action Elist).

Would you attend events on  (check all that apply):
Sundays  Weekdays  Evenings  Mornings  Afternoons

What would you like to gain from your membership in NCJW?

Please provide us with names and contact information of people you know who might like to join NCJW or would like information.