Bismarck Jaycees Membership Survey

Membership Survey

All fields marked with a * are required:

Roster Information:

Member's Name:* Spouse's Name:

Member's Birth Date:* Spouse's Birth Date:

Address:

Home Phone: Cell Phone:

Email Address:*

Name of Children:

Would child care be important to have at meetings:

Years you have lived in our community:

Member's Occupation: Spouse's Occupation:

Education Level:

Chapter Information:

Which evening is best for you to attend a meeting? Time:

What recent chapter projects have you attended?

Is there a project we conduct that you feel should be dropped?

What programs/projects are needed to conduct in our community?

Do you have the desire to serve in a leadership position?

Have you attended any training provided by the local chapter?

What type of training for personal or professional growth would you like to see the chapter offer?

Have you attended any state or national meetings? State: National:

Do you receive a newsletter?

How would you like to be notified about chapter events? Phone: Email: Text:

What would you change about the local organization?

Please recommend three (3) people who might join our organization:

1. Name: Contact:

2. Name: Contact:

3. Name: Contact:

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