Application for membership – DowneyElksLodge2020

Legal name of applicant: *

Maiden Name:

Select One *

Male

Female

Name of spouse: *

Home Address: *

City: *

State: *

Zip: *

Telephone Number: *

E-mail Address: *

Occupation: *

Business Name:

Business Address: *

City: *

State: *

Zip: *

Business Telephone Number: *

E-mail Address: *

By signing this application I hereby authorize the receipt of Lodge newsletters and statutorily required notices pursuant to Section 1.115 of the Grand Lodge Statutes by E-mail or other electronic means at the personal E-mail address listed above.

Yes

No

Applicant was born in the city of:

County:

State

Do you believe and God and are you willing to attest to that belief?

Are you a citizen of the United States of America?

If foreign born, when and where were your final naturalizatrion documents issued?

Month:

Day:

Year:

Are you willing to assume and obligtion that: (a) Will not conflict with your duties to yourself, or you family, or your religious or 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 or directly or indirectly participating in the activities of any group or organization, or supporting or adhering to beliefs or tenets advocating the overthrow of the Government of the United States or any of its political subdivisions by force or violence?

Have you ever pleaded guilty or no contest to or been convicted of a felony or crime of moral turpitude? *

Yes

No

(Any such plea or conviction must be disclosed even if the case was later expunged or dismissed. Such disclosure will not automatically prevent your membership in our Order, but may be a factor to be considered by the membership). I understand that the Lodge may perform a criminal background check to verify the information provided.

(a) Have you ever served in the armed forces of the United States of America?

(b) If yes, state the type of discharge and branch of service:

(a) Have you ever been proposed for memberhisp in any Elks Lodge?

(b) If yes, Lodge:

Date:

Result:

Have you been a bona fide resident within the jurisdiction of this Lodge immediately preceding the date of this application?

Provide two references other than the Proposer. Both must be Members of the Order.

1) Reference:

Name

Membership No.

Lodge Name and No.

Home Address:

Business Address:

Telephone:

Email:

2) Reference:

Name

Membership No.

Lodge Name and No.

Home Address:

Business Address:

Telephone:

Email:

List all places of residence and your occupation for the 5 years preceding the date of this application if different from the address and/or occupation given on reverse side.

1)

Place of Residence:

Date (Established/Changed):

Occupation

Telephone:

2)

Place of Residence:

Date (Established/Changed):

Occupation

Telephone:

EXCERPTS FROM LAWS OF THE ORDER
The Lodge Dues are per annum and may be paid semi-annually in advance of April 1st and October 1st of each year or annually in advance on April 1st of each year, as provided in the By-Laws of the Lodge. An Applicant rejected must wait six months before reapplying for membership. Rejected Applicants shall have their Initiation Fees returned to them by the Lodge.
Should a Candidate fail, without good cause, to appear for Initiation within four months from the date of the Candidate's election, the Exalted Ruler shall declare the Candidate's right to Initiation (under such application and ballot) void and the Candidate's Initiation Fee will be forfeited.
I understand that this application must be fully completed and accompanied by any application and initiation fees required by the Lodge; and that pro-rata membership dues, assessments and state association dues and fees, for the current year, must be paid at the time of initiation. I further understand that the Benevolent and Protective Order of Elks is a private organization, and that if I do not meet the established requirements and receive membership approval, I will not be granted admission into the Order.

Signature of Applicant (type your full name) *

Date: