*First Name
*Last Name
Please note who is 2nd Generation and family names if applicable
*Address
*City
*State
*Zip Code
*Email
*Phone
*Membership Type Family Membership ($36)Lifetime Membership ($360)
Please note - to complete your application, mail a check payable to CJHSA.
CJHSA P.O. Box 342 Southampton, PA 18966