Honorable Order of the Blue Goose, International
Application for the NOVA SCOTIA POND
Please complete
form online, print, and mail to:
Honorable Order of the Blue Goose International, Nova Scotia Pond
P.O. Box 1165, Halifax, NS B3J 2X1
3S7
Application must include Date of Initiation, Reinstatement or Flight
Date of New Membership: Date of Reinstatement: Date of Flight:
Applicant's Name:
Street Address:
Postal Address (if different):
City/Town:
Province:
Postal
Code:
Email:
Residential Phone: Business Phone:
Fax: Cell Phone:
Occupation (Last 6 Months):
Title/Position:
Date of Birth (ddmmyy): Spouse's Name:
Ever been a member of another pond? : If so, Name of Pond:
Ever been a Pond Officer? : Position & Dates Held:
Flight to: Pond from Pond and has paid dues for the fiscal year ending
New Member Vouched for by three Ganders
1) ___________________________________ Print 1)____________________________________Signature
2) ___________________________________ Print 2)____________________________________Signature
3) ___________________________________ Print 3)____________________________________Signature
Entertaining 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.
Applicants signature:__________________________________ Dated:__________________
Approved (Wielder)_______________________________ Dated:__________________ :