Seattle Pond Of Blue Goose

  Character, Charity, & Fellowship

Membership Application

               

  Download application at: 

 http://seattlepond.webs.com/BG Seattle Pond App.pdf

          

Honorable Order Of The Blue Goose International

    

 

APPLICATION FOR SEATTLE POND

 

One Time $30.00 Initiation Fee

Annual Dues only $50.00

 

 (Include check, made payable to Seattle Blue Goose, with completed application)

 

                             

                                                

                      

 

Application MUST INCLUDE DATE of initiation, reinstatement or flight:

 

Date of New Membership: _____________

Date of Reinstatement: _____________

Date of Flight: _____________

 

Applicants Name: ________________________________________________________________

Mailing Address: ________________________________________________________________

City: ___________________________________________________________________________

State or Province:___________Zip or PostalCode:___________________ 

E-Mail: ________________________________________________________________

 

Residential Phone: ________________________________________________________________

Business Phone: ________________________________________________________________

Cell Phone: ________________________________________________________________

Fax: ________________________________________________________________

Occupation (Last 6 Months): ________________________________________________________________

Title: ________________________________________________________________

Date of Birth: ________________________________________________________________

Spouse’s Name: ________________________________________________________________

 

Ever been a member of another pond? Yes_____ No____

If so, Name of the Pond? __________________________

Ever been a Pond officer? Yes_____ No____ Position & dates held: ______________________

 

Flight to_____________________ Pond from ____________________ Pond and has paid dues for the fiscal year

ending ______________________.

 

New Member Vouched for by three Ganders

 

1) ___________________________________ Print 1)____________________________________Signature

2) ___________________________________ Print 2)____________________________________Signature

3) ___________________________________ Print 3)____________________________________Signature

 

Entertaining a high regard for the aims and objects of the Honorable Order of the Blue Goose, International and promising to abide by

the Constitution and By – Laws, if admitted to membership, I hereby submit my application for membership.

Applicants signature:_________________________________ Dated:__________________

Approved (Wielder):___________________________________ Dated:__________________

 

 Send to Marylyn Graham, 2718 Nob Hill N, Seattle, WA 98109