Join an Oregon Elks Lodge

Join an Oregon Elks Lodge

Please fill out the form below to have your application submitted to an Oregon Elks Lodge

First Name

Last Name

Please provide your email address

Which Oregon Elks Lodge would you like to join?

Select

Mailing Address

City

State

Zip

Phone number

Phone

Cell phone

By proving my cell phone number I provide consent to receive phone calls and text messages regarding my membership.

Additional Application questions

There are additional application questions in order to complete your application. Would you like to complete some of those questions now?

Yes, I would like to answer additional application questions now

No, I would prefer to wait to provide additional information until contacted by the lodge.

Spouses name

Please list your occupation

Please list your place of employment

By signing this application I hereby authorize the receipt of Lodge newsletters and statutorily required notices pursuant to Section I . 115 of the Grand Lodge Statutes by E-mail or other electronic means at the personal E-mai I address I isted above.

Select or enter value

Applicant was born in the city of:

County of birth:

State of birth?:

Birth Month

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Birth Day

Select

Birth Year

Do you believe in God and are you willing to attest to that belief?

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Are you a citizen of the United States of America

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If foreign born , when and where were your final naturalization papers issued:

Month final naturalization papers issued

Day final naturalization papers issued

Year final naturalization papers issued

Location final naturalization papers issued

Are you willing to assume an obligation that:

(a) Will not conflict with your duties to yourself, or your family, or your religious or political opinions and that

(b) Will bind you to uphold the Constitution and laws of the United States of America

Select

Are you now a member of or directly or indirectly participating in the activities of any group or organization, or supporting or adhering to beleifs or tenets advocating the overthrow of the Government of the United State or any any of its political subdivisons by force or violence?

Select

Have you ever pleaded guilty or no contest to or been convicted of a felony or crime of moral turpitude?

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 in the our Order, but may be a factor to be considered by the membership.) I understand that the lodge may perform a criminal background check to verify the information provided.

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Have you ever served in the armed forces of the United States of America

Select

If yes, state the type of discharge and branch of service:

Have you ever been proposed for membership in any Elks Lodge

Select

If yes, Lodge:

Date of prior proposal:

Result of prior application for membership:

Have you been a bona fie resident within the jurisdiction of this Lodge immediatly precedign the date of this application?

Select

Send me a copy of my responses

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