To Join JACO
JACO Membership Form

 

Name(s)_______________________________________

Address________________________________________

Phone (Home)__________________________________

(Work)_________________________________________

eMail___________________________________________

_______________________________________________

 
City, State, Zip____________________________________________  
 

 

I/We wish to join JACO. (Please circle $ amount.)
Category 1-Person 2-Persons
Basic Membership $50 $75
Student (full-time) $25
Sustaining $125 $200
Patron $300 or $25/mon. $420 or $35/mon.
Philemon Circle $600 or $50/mon. $720 or $60/mon.
Associate (Mailing List) $25  

I have enclosed $________to cover dues.

Please mail form (check payable to)
JACO, 59 W. Third Ave., Columbus OH 43201

I wish to pay by:

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Card#___________________________________________
 
Expiration Date__________________________________

Signature_______________________________________

Date____________________________________________

Your membership is tax deductible.
Click here to register online.

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Ohio Valley Association of Jungian Analysts