Christian Jugglers Association Membership Form

1.  What type of membership would you like (International members can only choose web based.)

5 year web based membership ($15US) 1year postal ($8US) 5 year postal ($40US)

2. How can we expect to recieve your money: PayPal to Nathan@crazytieguy.com   US check or US postal money order

3.  Personal Information:

Name

Street AddressCity

State Zip CodeCountry

Birthday

Church Affiliation:

Other interests/hobbies:

Email:Web Address:

How did you find out about the CJA:

Briefly describe how you became a Christian, how you became a juggler, and how you hope the CJA can help you be the best Christian juggler you can be:

4.  Ministry Information:  Fill out this section only if you wish to be listed in the section of Christian Performers on our web site. We will list the information below so people can easily contact you and book you for performances at their church, outreach or ministry.

1. Stage name/ministry name:
2. Quickest Contact: Phone:Email:
3. During what hours are you easiest to contact:
4. I have Christian Juggling presentations for (example: kids events, outreach)
5. Length of presentations: minutes to minutes/hours minutes is my preference
6. Can travel within mile radius
7. How soon in advance I need to be contacted:
8. Special information:
9. Are your performances good for all denominations?explain:
10. Write a brief description of your ministry. Explain what you do for God, churches, ministries and other Christian organizations with juggling.

Date: