First and Middle Name: Last Name:

GenderHeSheThey

Date of Birth (We would like to send you Happy Birthday message!)

Address

Phone Number:

Email Address:

Social Netowork Account (for website, etc.):

Membership TypeIndividualFamilyCorporate

Payment Method Cash Venmo （Account Name：） Paypal （Account Name：） In Person(at workshop / event )

The membership year begins in April.
Dues are non-refundable.
Membership may be revoked by the Board if deemed harmful or inappropriate.
Please notify us in advance if you do not want your photo taken at workshops or events.
Please notify us if you do not wish your name listed in the Directory.
Event photos may be posted on social media. If you do not wish your face to appear, please inform the staff beforehand so we can blur your image.
JIOSTL is not liable for any accidents, injuries, or damages that occur during events or workshops. Participation is at your own risk.
We are a 501(c)(3) nonprofit. Your donation and volunteer support empower our community and may be tax-deductible. Thank you for being part of something meaningful.

Event Volunteer: AvailableUnavailable

Workshop VolunteerAvailableUnavailable

Other Volunteer: Available （Skills：） Unavailable

Workshop/Event Requests:

Suggestions for JIOSTL:

Signature

Date:

JapaneseInstitute of St.Louis ★ Membership Application