I apply for membership in the Grande Prairie Elks Lodge No. 285 I have never been a member of the Order I was a member and am appliying for re-instatement I am a member of another Lodge applying to join as a plural member My address is: Street/Box no. City ProvinceSelect OneAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Phone (res) Phone (Bus) Email Birthdate12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 19121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000 References: Name Address Phone Name Address Phone Do you believe in the maintenance of law and order? Yes No Have you ever been convicted of a criminal offence for which you have not received a pardon? Yes No If Yes, please explain Are you willing to assume an obligation that will not conflict with your duties to yourself, family, your religious belief or political opinion? Yes NO Have you ever been proposed for membership in any other Elks Lodge? Yes No If Yes, what Lodge and with what results? Please check the appropriate categories you are interested or have a specific talent in: Finances Computers Public Speaking Fund Raising Communications Sports (list types) Other / list What is your present occupation? Do you think you might like to become an Officer or a member of a Committee? (optional) Yes No Possibly Please list the names of any other organizations that you have belonged to and any offices of positions held in these organizations: The Elks of Canada respects your privacy. We protect your personal information and adhere to the Personal lnformation Protection and Electronic Documents Act. The information you provide will be used to provide you with the benefits of membership in the Elks of Canada. lf at any time you wish to limit the use of this information, or would like to receive more information about our privacy policies please call our Privacy Officer toll free at 1-888-843-3557 or visit our website at vvww.elks-canada.org. Our organization has prospered since 1912 because of the high caliber of members who have joined. They have been interested in the fellowship provided, and in helping those less fortunate. We urge you to become knowledgeable about the organization, to become active in our work and to assure the continued strength of our Order through proposal of your friends as members. Please consider yourself an ambassador of the Elks and part of the Membership Committee.