MEMBERSHIP APPLICATION

Member Application

Part 1 of 2: Applicant Information

It takes about 10 minutes...

The membership application to our order is below. The first portion of the application collects your information, and the second portion is for collecting the application fee. You must complete both portions to be considered. You will receive 2 confirmation emails, the first being a review of the information provided and the second a receipt from our online-ordering system. The secretary will reach out to you within 2 weeks for further instruction. For further questions on timing and the process, please re-visit our "Apply Now" page.

First Name*

Last Name*

Gender

Spouse First Name

Spouse Last Name

Email*

Phone # Ex. 1-234-567-8910*

Home Address*

City*

State*

Zip*

Lodge Communications: *

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.

I agree

Your City of Birth*

State of Birth*

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

Are you a citizen of the United States of America?*

If foreign born...

Where were your final naturalization papers issued?

When were your final naturalization papers issued?

Are you willing to assume an obligation that:
(a) Will not conflict with your duties to yourself, or your 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?

Note: Any such plea or conviction must be disclosed below 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.

*

If yes, please explain the situation.

Have you ever served in the armed forces of the USA?*

If yes, state the type of discharge and branch of service.

Have you ever been proposed for membership in any Elks Lodge?*

If yes, please state the Lodge

Proposed Date

Result

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

Please list any sponsors (i.e. proposers) you may have (separated by a comma, must list at least one person).*

EXCERPTS FROM LAWS OF THE ORDER:

The Lodge Dues are per annum and may be paid semi-annually in advance of April lst 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.

Please list any additional comments you may have below.

Digital Signature (Please type your full name):*

Signed Date*

Form could take up to 30 seconds to submit.