Y-O-U can make a difference in the life of a child!

Please fill in the info requested, and we will contact you soon to follow-up on how YOU can make a difference! Note: We take the confidentiality of your information very seriously; at no time is this information made available to others, for any purpose...period.

My Name:

Title/Position:

Firm/Organization (or Retired, School Name if a Student, etc.):

Mailing Address:

Daytime Phone:

E-mail Address:

Sex: Female Male

Supervisor's Name: Supervisor's Title:

My Role: Business Person Educator Parent Returning Volunteer Student Other

Level of Interest: Need more information Ready, SIGN ME UP!

Program(s) I am interested in (if more than one, hold the 'Ctrl' key down while selecting):

We want to know your preferences...but PLEASE be flexible!

City Preferred, if any:

School(s) Preferred, if any:

Day(s) of Week Preferred, if any:

Time of Day Preferred (morning, lunch, early p.m.):

How did you hear about Junior Achievement?

Comments?

Have questions? Contact Judy Reagan at 601-948-3997 or judy@ja-mississippi.org. THANK YOU for your interest; we'll be in touch with you soon!