Application for Membership Mattole Grange No. 569
To the officers and members of Mattole Grange No. 569:
I respectfully apply to be enrolled as a member of your Grange.
Name ________________________________________
Street or Box No. _______________________________ City ________________ State _____ Zip _________
Telephone ( ) ___________ Birth date ___________
E-mail ________________________________________
Occupation_____________________________________
If retired – Former occupation ______________________
Have you ever been convicted of a felony? ____________
( if yes, you would not be eligible for membership according to Grange by-laws)
In presenting this application, I am influenced by no motive other than a desire to unite with
others in elevating and advancing the interest of animal husbandry and rural land. Receiving in return,
such benefits and advantages as may accrue to all who belong to the Grange.
I promise a faithful compliance with the by-laws of this Grange, the National Grange, the Constitution and Laws of the State.
Signature of applicant _________________________________________ Date ____________
References (1) __________________________________ (2) ___________________________
Please tell us a little about yourself and why you would like to be a member of the Grange.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Please indicate any Volunteer Activities you may be interested in.
BBQ EVENTS PANCAKE BREAKFASTS
____ Preparation of or serving meat ____ Cooking
____ Preparation of or serving beans ____ Waiting tables
____ Helping with pastry sales ____ Clearing tables
____ Clean Up ____ Cashier
____ BUILDING/GROUND MAINTENANCE
Application fee: $5 (payable to Mattole Grange) Annual Dues: $37
Return application and fee to Jeanne Mattole, P.O. Box 137 Honeydew, CA 95545.
For additional information please contact Jeanne at 629-3653.
FOR SECRETARY’S USE ONLY
Date mailed ____________ Date Approved ___________ Date sworn in ____________
Revised 04/28/2007