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Santa Ynez Chapter
prospective Member Information
Before you start.
Please download the New Member Information Packet below.
2017-2018 New Membership Application
File Size:
1411 kb
File Type:
pdf
Download File
PROSPECTIVE MEMBER INFORMATION
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Indicates required field
Prospective Member’s Name
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First
Last
Birth Date (MM/DD/YYYY)
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Number of years in the community
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Select one
Less than one year
1 - 3 years
3 - 5 years
5 - 7 years
7 - 10 years
More than 10 years
Email
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Home Phone Number
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Cellphone Number
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Emergency Contact Name
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First
Last
Emergency Contact Number
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Prospective Ticktocker Member Information
Name
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First
Last
Father’s Name
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First
Last
Fathers Phone Number
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Birth Date (MM/DD/YYYY)
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Grade Level next Sept.
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Select one
7th
8th
9th
10th
School attending in Sept.
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Select one
Santa Ynez Valley Charter School
Santa Ynez Valley Chrstn Academy
Santa Ynez Elementary School
Santa Ynez Valley Union High School
Midland School
Dunn School
Los Olivos Grammar School
The Family School
Jonata Middle School
Olive Grove Charter School
Vista del Mar
Home Schooled
Other (Please use text box below)
Other School (If not listed)
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Address (If different from Mothers)
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Line 1
Line 2
City
State
Zip Code
Country
Other
CHILDREN
Please List any Younger Daughters in the Family
Name
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Birth Date (MM/DD/YYYY)
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Year Entering 6th Grade
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Name
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Birth Date (MM/DD/YYYY)
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Year Entering 6th Grade
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Please List Other Children in the Family and their Ages
Name
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First
Last
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Current Age
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Name
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First
Last
Current Age
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Other affiliations
Please List any Current organizational affiliations, community and volunteer positions
Organization
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Position Held
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Length of Involvement
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Organization
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Position Held
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Length of Involvement
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about you
Please list any special interests, abilities and hobbies
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How would you describe yourself?
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Do you know anyone currently in NCL?
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Yes
No
If Yes, please provide name
Name
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First
Last
What about membership in NCL interests you?
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Declaration and membership agreement
PLEASE READ AND SIGN THE FOLLOWING BY ENTERING YOUR NAME IN THE BOX BELOW
:
I have been informed of membership Obligations for my daughter(s) and myself. We are willing to fulfill these commitments.
I understand that National Charity League, Inc. reserves the right to search public record and to deny or terminate membership based on any conviction of a felony.
Has your sponsor done a thorough job of explaining NCL to you?
*
Yes
No
I understand that I am being proposed for membership in the National Charity League, Inc., Santa Ynez Chapter. I understand the long term commitment and expectations of volunteers in NCL. I have been informed of and understand all attendance, hours and financial expectations and obligations. I am willing to fulfill these commitments, and wish to be considered for membership in the Santa Ynez Chapter.
I understand and agree that the information in my packet will be reviewed and verified by the Membership Committee and that my name may be presented to the general membership of the Chapter. I further understand that membership is not guaranteed and that the decision of the Santa Ynez Chapter Board of Directors is final.
Prospective Patroness Signature (Please enter your Name in the box below)
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Prospective Ticktocker's Signature (Please enter your Name in the box below)
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Submit