Applying For Membership

We seek members who are interested in making a difference in our community and are willing to contribute their time and talents to the organization. In order to apply to the 100 Black Men of Jacksonville, interested persons must be
(1) at least twenty-one years of age and
(2) nominated by a current member.
The candidate is asked to submit an application, complete an interview and submit to a background screen to complete the membership process.

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Register

The first step is to register on our website.

Done

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Application

The next step to membership in the 100 Black Men of Jacksonville is completing an online application.

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Interview

Once your application is submitted, a member of the J100 will contact you to schedule an interview.

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Background Check

Because of the J100’s work with minors, applicants are required to consent to a background check. After a successful interview you will be contacted to complete the final step of the membership process.

Membership fees are due after a successful interview. Membership dues are $300 per year + payment processing fee of $7.00. This will also cover the required background checks. The cost of the background check is non-refundable. Please contact us if you have any questions at (904) 764-2445.

Step #2: Complete The Application

* Required Fields

Applicant Information


Name*
Referred By
Email*
Mobile Phone*
Street Address*
State*
Date of Birth*
Home Town
City*
Zip*


Business/Occupation Information


Employer Name
Employer Industry
Self-Employed? Yes
Employer Website


Emergency Contact Information


Emergency Contact Name
Emergency Contact Phone
Emergency Contact Street Address
Emergency Contact State
Relationship
Emergency Contact City
Emergency Contact Zip


Spouse Information


Spouse Name


Military Information


Branch
Rank
Period Served


Community/Professional Affiliations


Hobbies, Activities & Interests





Education


HIGH SCHOOL
School
Degree
Year
UNDERGRADUATE
School
Degree
Year
GRADUATE
School
Degree
Year
OTHER
School
Degree
Year


Areas of Interest


Submit Application


I confirm that the information presented on this application is true and accurate to the best of my knowledge.