SAJAC Family Listings

The cost of membership for a SAJAC Family is $40.00 per year. The membership fee is due on January 1st of the each year. After registration and activation, we will provide you a link to purchase your membership online using PayPal.

Login Information

Username*

Password*

Confirm Password*

Family Details

Please complete this section - this information all becomes part of the family profile.

Family Last Name*

Street Address*

Apt / Suite

City*

State*

Zip*

Phone Number

() -

Family Contact Details

The family contact details identify a single person within the family to act as the contact person. Please complete this section.

Contact First Name*

Contact Last Name*

Contact E-mail address*

Even though you can add family members at any time, it is easiest to do this as part of the profile setup. When adding new family members, please be sure to include the first name and last name for each family member.

Family Members - Head of Household
First Name*		Last Name*
Date of Birth*	/ /	E-mail Address*
Family Members - Spouse
First Name		Last Name
Date of Birth	/ /	E-mail Address
Family Members - Child 1
First Name		Last Name
Date of Birth	/ /	E-mail Address
Family Members - Child 2
First Name		Last Name
Date of Birth	/ /	E-mail Address
Family Members - Child 3
First Name		Last Name
Date of Birth	/ /	E-mail Address
Family Members - Child 4
First Name		Last Name
Date of Birth	/ /	E-mail Address
Family Members - Child 5
First Name		Last Name
Date of Birth	/ /	E-mail Address

Enter the code exactly as it is shown in the box below*