| Form
Name: |
|
| Proposing
Elks Member: |
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|
Under
the Obligation of the Order, I propose the following applicant
for membership. |
| Member's
Address: |
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| City,
State, Zip: |
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| Phone
Number: |
Member
#: |
| Email
Address: |
|
| Signature: |
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|
By
typing your name in this online form, it is considered as a legal, binding
signature. |
| APPLICANT
INFORMATION |
| Applicant's
Name: |
|
| Spouse's
Name: |
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| Applicant's
Address: |
|
| City,
State, Zip: |
|
| Phone
Number: |
Alt.
Phone: |
| Business
Name: |
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| Occupation: |
|
| Business
Address: |
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| City,
State, Zip: |
|
| Business
Phone: |
Extension: |
| Email
Address: |
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| Birth
City, County, State: |
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| Birth
Month, Day, Year: |
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| Do
you believe in God? |
|
| Are
you a Citizen of the United States? |
|
If
foreign born, when and where were
final naturalization papers issued? |
|
|
Are
you willing to assume an Obligation that:
(a) Will not conflict with your duties to yourself, your family,
or your religious & political opinions and that
(b) Will bind you to uphold the Constitution and laws of the
United States of America? |
|
|
Are
you now a member of the Communist Party or indirectly connected
or affiliated with the Communist Party, or with any organization
or group advocating or believing in the overthrow of the
government of the U.S. by force? |
|
| Have
you ever been convicted of a felony or a crime of moral turpitude? |
|
| If
you have ever been discharged from the Armed Services of the United States
or any of its Allies, state the character of the discharge received: |
|
| Have
you ever been proposed for membership in any Lodge of this Order, if so,
where and when and with what result? |
|
| Have
you been a bona fide resident within the jurisdiction of this Lodge
immediately preceding the date of this application? |
|
|
Give references of at least two Members of this Order, other than Proposer, and complete fields below for each: |
| Name |
Home Address |
Business Address |
Phone |
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Give the name of each place of your residence you have had during the last 5 years preceding the date of this application specifying date of each change therein, also the occupation followed by you in each place: |
| Place of Residence |
Dates
of Residence |
Occupation |
Phone |
|
From:
To: |
|
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|
From:
To: |
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The above form must be fully filled out by the Proposer and the
Applicant
and be accompanied by an Application Fee,
or it will not be considered.
Balance of Initiation Fee and proportionate Annual Dues up to next April 1st must both be paid at time of Initiation. |
| Signature of Applicant:
|
Date:
, 20 |
|
By
typing your name in this online form, it is considered as a legal, binding
signature.
|
