Get Supreme Emblem Application Form

National Organization of Emblem Clubs The Supreme Emblem Club of the United States of America Application for Membership Reinstatement or Demit or Dual Membership The following information is to be verified by Club Membership Chairman for accuracy before submitting to Club Financial Secretary CLUB NAME NUMBER DATE CLUB ADDRESS P. O. Box City State 9 Digit Zip Code The following to be completed by Applicant Name of Applicant Month Date of Birth Name of Spouse Month Date of Anniversary Address Tel Home Tel Work Are you at least 16 years of age Zip / - Occupation Are you an American Citizen Have you been convicted of a felony If yes please explain Name of Emblem Club Sponsor Do you believe in God Emblem Sponsor Club Number Signature of Emblem Club Sponsor Name of Elk Relative/and or Sponsor Elk Sponsor Lodge Number Are you a former Emblem member If yes Club Name Did you serve as a Past President No Yes Club Number When When and How was membership severed I enclose with this application Annual Dues and the Initiation Fee of Signature of Applicant Date FALSIFICATION OF ANY INFORMATION SHALL RESULT IN EXPULSION OF MEMBER Note Membership is contingent upon a majority vote of the membership. If accepted the applicant will be notified of the date time and place of Initiation. If not accepted for membership all money will be refunded and applicant will be notified with a courteous letter. Applicant not accepted for membership may apply again in six 6 months. Only a new member is to be initiated. THE FOLLOWING IS TO BE COMPLETED BY THE CLUB FINANCIAL SECRETARY AND RETAINED PERMANENTLY IN CLUB FILE Note If this form is used for purpose of a Demit a Demit Form must still be issued to member for presentation to the Club for acceptance. Member must reinstate in the Original Club before being given a Demit by Original Club. Please order Demit Form from the Supreme Publications Manager address inside front page of Topics. O. Box City State 9 Digit Zip Code The following to be completed by Applicant Name of Applicant Month Date of Birth Name of Spouse Month Date of Anniversary Address Tel Home Tel Work Are you at least 16 years of age Zip / - Occupation Are you an American Citizen Have you been convicted of a felony If yes please explain Name of Emblem Club Sponsor Do you believe in God Emblem Sponsor Club Number Signature of Emblem Club Sponsor Name of Elk Relative/and or Sponsor Elk Sponsor Lodge Number Are you a former Emblem member If yes Club Name Did you serve as a Past President No Yes Club Number When When and How was membership severed I enclose with this application Annual Dues and the Initiation Fee of Signature of Applicant Date FALSIFICATION OF ANY INFORMATION SHALL RESULT IN EXPULSION OF MEMBER Note Membership is contingent upon a majority vote of the membership* If accepted the applicant will be notified of the date time and place of Initiation* If not accepted for membership all money will be refunded and applicant will be notified with a courteous letter.