J Perks Pass Membership Registration

J Perks Pass Registration
Name*

First NameLast Name
Email*
Newsletter

YES, I'D LIKE TO RECEIVE EMAILS FROM JCC DENVER
Phone number*

Area CodePhone Number
Birthdate*

MonthDayYear
Date
Current Membership type*
Which program area are you most excited to join?*

Camp ShaiRanch CampAdult Art ClassesYoung Family EngagementYouth SportsTeen ProgramsOther
Membership Options

We are excited to offer a NEW J Perks Pass Membership! You may choose from an Individual Membership ($180/year) or a Family Membership ($360/year).

Select your membership and payment below, no matter which option you choose your membership is valid for 12 months from the purchase date. Renewal is not automatic, you will be offered the option to renew your membership at the end of your term. Membership payment plans must be completed in full prior to program registration. We are unable to offer refunds for the J Perks Pass Membership.

Payment plans are available on request, please contact Judy Swesey jswesey@jccdenver.org for further information.
Membership Join Date*

MonthDayYear
Date

Membership selection & payment*

J Perks Pass - IndividualMembership is valid for 12 months from the purchase date.

$180.00 one-time payment

J Perks Pass - FamilyMembership is valid for 12 months from the purchase date.

$360.00 one-time payment

J Perks Pass - Individual (Payment Plan)Membership is valid for 12 months from the purchase date. The first payment is due at the time of purchase, the second payment is due 2 weeks from the time of purchase, the third payment is due 4 weeks from the time of purchase. Payment plans must be paid in full prior to receiving program registration benefits.

$60.00 for each two weeks

J Perks Pass - Family (Payment Plan)Membership is valid for 12 months from the purchase date. The first payment is due at the time of purchase, the second payment is due 2 weeks from the time of purchase, the third payment is due 4 weeks from the time of purchase. Payment plans must be paid in full prior to receiving program registration benefits.

$120.00 for each two weeks

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

How many same-household family members will be on your J Perks Pass?*
Do not count yourself. Only those included in the membership will receive member benefits.
Family member 1 name*

First NameLast Name
Family member 1 birthdate*

MonthDayYear
Date
Spouse Email
example@example.com
Family member 1 relationship*
Family member 2 name*

First NameLast Name
Family member 2 birthdate*

MonthDayYear
Date
Family member 2 relationship*
Family member 3 name*

First NameLast Name
Family member 3 birthdate*

MonthDayYear
Date
Family member 3 relationship*
Family member 4 name*

First NameLast Name
Family member 4 birthdate*

MonthDayYear
Date
Family member 4 relationship*
Family member 5 name*

First NameLast Name
Family member 5 birthdate*

MonthDayYear
Date
Family member 5 relationship*
We require you to verify your identity by receiving a one-time passcode via SMS.*
Should be Empty:

J Perks Pass Registration