Application For Membership

To: Most Loyal Gander of the Greater Chicago Pond.

Having read the ancient history, and professing 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 in the Greater Chicago Pond.

Please add my name to the Chicago Pond mailing list.  I understand that full membership to the Grand Nest is subject to approval of the Officers, payment of dues, and only upon my initiation at a future Induction Ceremony.  Annual membership runs from July 1st to June 30th.

Your name will be added to our mailing list upon receipt of $45.00 Annual membership dues.  Please send check payable to "Blue Goose" along with your business card to:

Blue Goose Chicago Pond
P.O. Box 3713
Oak Brook, IL  60522-3713

Please provide the following contact information:

First Name  
Last Name  
Middle Initial
Title  
Organization  
Street Address  
Address (cont.)
City  
State/Province  
Zip Code  
Country
Work Phone  
Fax  
E-mail  
Home Address
Home City
Home State
Home Zip Code  
Home Phone  
Have you ever been a member of another Pond?
If so, please check box below and enter name of Pond.

    

Other Pond

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Revised: May 29, 2006

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Last modified: February 29, 2004