| State or Province | – |
|---|---|
| City | – |
| Country | – |
| Postal Code | – |
| Name on Certificate | – |
| Name on Name Tag | – |
| State on Name Tag - US Residents Only | – |
| Country on Name Tag | – |
| Would you like to be added into the Live Event JMT App Directory? | No - Do NOT Include Me in Event Directory |
| Spanish Members - Would you prefer your event materials in Spanish? | – |
| Live Translation | – |
| Spanish Preferred Language | – |
| Spanish Activities Participation | – |
| Dietary Needs | – |
| Special Accomidations | – |