San Jose Elks Membership Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *Gender *MaleFemaleName of Spouse (enter N/A if not applicable)Applicant Address: *Applicant City: *Applicant State:Applicant Zip: *Applicant Born in what city: *Born in what county: *Born in what state: *Date of Birth: *Applicant's Occupation: *Applicant's Employer Name:Applicant Employer Address:Applicant Employer City / State / Zip:Applicant Employer Phone: Zip: your which Do you agree to accept electronic communications from the Elks include Elks Magazine Lodge Newsletters and any notices required to be sent to all members of the lodge? *YesNoDo you believe in God and are you willing to attest to that belief? *YesNoAre you a citizen of the United States of America who will pledge your allegiance and salute our Flag? *YesNoIf you are foreign born, please indicate what date and where your final Naturalization papers were issued? Are you willing to assume an obligation that: *Will not conflict with your duties to your family, or your religious or political opinions.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 of America or any of its political subdivisions by force or violence? *YesNoHave you ever pleaded guilty or no-contest to or been convicted of a Felony or crime of moral turpitude?YesNoNote: 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, but may be a factor to be considered. I understand San Jose Elks may conduct a criminal background check to verify the previous question. *YesNoHave you ever served in the Armed Forces of the United States of America? *YesNoIf Yes, please indicate which military branch you served.Have you ever been proposed for membership in any Elks Lodge? *YesNoIf Yes, please indicate which Elks Lodge & Date:If you were previously proposed for Elks Membership, please indicate result:Are you a bona fide resident within the jurisdiction of the San Jose Elks Lodge? *YesNoPersonal Reference 1: *Personal Reference 2: *Anything else we should know?Submit
