Online Membership Application Form

Name

Applicant's Full Name

Applicant's Email

Today's Date

Home Phone

Date of Birth

Cell Phone

Your Occupation

Spouse's Full Name

Spouse's Cell Phone

Spouse's Email Address

Spouse's Occupation

Spouse's Date of Birth

Full Residence Address (Include Street, City, State, Zip)

Number of Years I have resided in this city (include years and months)

Church Affiliation

I was a previous member of this club (please provide date)

Reason for terminating my membership

First Sponsor (please provide name of your sponsor)

Second Sponsor (please provide name of your second sponsor)

List of Children and their Birthdays

As a member of the Phoenician Club, your name will automatically be submitted for membership to the Southern Federation of Syrian Lebanese American Clubs. Choose NO if you DO NOT want your name submitted. As a member of the Phoenician Club, your name will automatically be submitted for membership to the Southern Federation of Syrian Lebanese American Clubs. Choose NO if you DO NOT want your name submitted. NO

FIELDS BELOW FOR OFFICE USE ONLY

Date application initiated:

Elected to membership:

Date applicant rejected:

Reason for rejection:

Notification date:

Membership Chair:

Secretary: