Membership Application

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IJJA Membership Application

Please fill this form out completely as our membership registration is now done completely online.

If you need to register more than one person, click on “+Add Additional Member” at the bottom of the form. You can add as many members as necessary.

When you are finished adding members, click the “Submit” button and you will be taken to the payment page for credit card or PayPal payments.

If you prefer to pay by check, click the box next to “Pay With Check” and again click on the “Submit” button. You will be notified that your members were added.

With both payment options you will receive an email confirmation with additional instructions if necessary.

If you are paying by check let us know if you need an invoice to submit for payment. One will be sent to you.

Agency *

Contact Person *

District *

Address *

City *

State *

Zip *

Phone *

Fax *

Email *

Add Members

Member 1

Last Name *

First Name *

Cell # *

Email *

Please indicate which age/category this member works with:

Juvenile Adult Misdemeanor Other If Other Please Specify:

Please check all that apply

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Add Additional Member
Total: $35.00
Pay With Check