Member Application

First Name

Last Name

Preferred Email

Address 1

Address 2

State / Province

City

Zip / Postal Code

Country

Preferred Phone

Alternate / Mobile Phone

Employment / Company

Occupation

Spouse / Partner

Pond

Application Fee

Cardholder Name

Card Number

CVC

Exp Month (MM)

Exp Year (YYYY)

Acceptance Policy

Submitting an application is the first step toward becoming a member of the Honorable Order of the Blue Goose, International. Applications must be accepted by the local Ponds and applicants vouched for by three (3) active Ganders before being formally initiated into membership.

By submitting this application, I confirm my high regard for the aims and objectives of the Honorable Order of the Blue Goose, International, and I promise to abide by the organization's Constitution and By-Laws if admitted to membership.