Thank you for your interest in becoming a Junior Civitan.Please complete the following form. You will receive a follow-up email from those responsible for the Junior Civitan Club. Your InformationYour Name *Street AddressTown *Postal Code *Age *Grade *Date of Birth *Phone *Email Address *Parent's Name *Parents Phone Number *Parents Email Address *AgreementI hereby request membership in the Almonte Junior Civitan Club. Upon acceptance, I agree to abide by the International, District and Club constitutions, bylaws and policies.I agree to the terms above. *YesNo Send Application