Last Name:

__________________________

First Name:

___________________________

Mailing Address:____________________________________________________________

City:

________________________________

State:

_______

Zip Code:

_______________

Company:	________________________	Position:	________________________
Work Phone:	________________________	Fax:	________________________
Home Phone:	________________________	Fax:	________________________
Cellular:	________________________	E-mail:	________________________

Please answer the following questions:

1. Are you a full time member/employee of the jewelry industry?

Yes_____

No _____

If not, please explain on the back of this sheet.

2. Have you ever been the focus of a dispute or action with JAG?

Yes_____

No _____

If so, please explain on the back of this sheet.

3. Have you ever been convicted of a felony?

Yes_____

No_____

If so, please explain on the back of this sheet.

Please list your Professional Associations:

Please list your Educational background and/or Trade experience:

MEMBERSHIP AGREEMENT
If accepted as a member of the Jewelers Advisory Group (JAG), I promise to uphold, maintain, and promote a high level of ethical, educational, and professional standards for the Jewelry Industry. Where there is conflict between members of the trade, or between the trade and public, I will strive to effect a positive resolution for all parties according to the principles of truth and fairness. I will furthermore strive to promote cooperation, community, harmony and good will amoungst my fellow tradesmen. I furthermore pledge to honor the ideals of JAG by telling the truth about myself, my business, and my merchandise.
My check for $75.00 for my yearly dues is enclosed.

Signed: ________________________________________

Date: __________________________________________