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Get Jack and Jill of America Legacy Membership Request Form

Jack and Jill of America Incorporated Since 1938 Legacy Membership Request Form Deadline for filing a Legacy Request is January 31 in order to be considered for initiation prior to May 31. Requesting Membership Information Basis for Legacy Self Spouse Instructions This form must be submitted to the National Office by the Chapter President. Jack and Jill of America Incorporated Since 1938 Legacy Membership Request Form Deadline for filing a Legacy Request is January 31 in order to be considered for initiation prior to May 31. Requesting Membership Information Basis for Legacy Self Spouse Instructions This form must be submitted to the National Office by the Chapter President. In the event that chapter files do not verify the Mother s tenure submit one of the following along with this form 1. Copy of Completion of Tenure form 2. Notarized letter verifying tenure from financial member/former member who held concurrent membership with the Mother Chapter Affiliation Requested Name Address Region City State Email Phone No* Zip Spouse s Name Legacy Information Living Mother of Legacy Name of Legacy Mother s Last Chapter Affiliation Deceased Children of Legacy M Birth Date Mother s National Per Capita Tax F Year Paid Mother s Headquarters Assessment Paid Yes No N/A Note Chapter Presidents are requested to send a letter accompanying the request verifying the legacy mother s membership status at the end of her membership term and the compliance with local and national bylaws. Signature of Person Requesting Membership Date of Request Legacy Mother s Signature unless deceased Date of Approval 1930 17th Street NW Washington DC 20009 www. jackandjillinc*org 202 667-7010 To be completed by the Chapter President Mother completed tenure in good standing Mother s Membership ID Number Mother s Last Year of Active Membership Send all completed copies of this form to National Headquarters. The deadline for filing a Legacy Request is January 31 in order to be considered for initiation prior to May 31. Requesting Membership Information Basis for Legacy Self Spouse Instructions This form must be submitted to the National Office by the Chapter President. In the event that chapter files do not verify the Mother s tenure submit one of the following along with this form 1. In the event that chapter files do not verify the Mother s tenure submit one of the following along with this form 1. Copy of Completion of Tenure form 2. Notarized letter verifying tenure from financial member/former member who held concurrent membership with the Mother Chapter Affiliation Requested Name Address Region City State Email Phone No* Zip Spouse s Name Legacy Information Living Mother of Legacy Name of Legacy Mother s Last Chapter Affiliation Deceased Children of Legacy M Birth Date Mother s National Per Capita Tax F Year Paid Mother s Headquarters Assessment Paid Yes No N/A Note Chapter Presidents are requested to send a letter accompanying the request verifying the legacy mother s membership status at the end of her membership term and the compliance with local and national bylaws. .

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