Name (First,Last):____________________________________ Date: _________________________

Check/Postal Money order enclosed : Amount _________

INSTRUCTIONS: If you would like to fill this out online--click this online membership form.  Otherwise, please print and fill out this form and mail it with a check/money order (residents outside the US paypal only send paypal money to Nathan@crazytieguy.com with "CJA membership" and your email and address):

The CJA is an organization that exists to encourage Christian jugglers in their faith and help them to better serve and worship God through their talents. The cost of membership is $8/year for a postal membership in the US, $10US in Canada . OR you can choose the 5 year web-based membership for $15/5yrs.  Web members receive the same benefits except the newsletter is sent via email or you can upload it from our members area on the web.  Make payable to Nathan Dorrell. You will receive 4 newsletters per year and ministry support on the web.

MEMBERSHIP TYPE (check one and send appropriate amount of money)

          {   } 5 year web-based ($15 US/Canada or International members)

         {   } 1 year postal mail ($8 in US/Canada only)...................{   } 5 year postal mail ($45 US/Canada residents only)

Street Address________________________ City__________________________________ 

State_______________ Zip Code_______________Country________________________

Birthday________________

Church Affiliation:___________________________________________________________

Other interests/hobbies:_______________________________________________________

Email:__________________________ Web Address:_______________________________

How did you find out about the CJA:_____________________________________________

On the back of this paper, 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.

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. Willingness to travel: ___________________________________ ? will travel anywhere
7. How soon in advance I need to be contacted: ______________________________________
8. Special information:__________________________________________________________
9. Are your performances good for all denominations?______ explain:____________________
10. On the back, write a brief description of your ministry. Explain what you do for God, churches, ministries and other Christian organizations with juggling.

Signature:_______________________________________________ Date:_________________