APPLICATION MUST BE RECEIVED BY October 10, 2008

APPLICATION FOR MEMBERSHIP

ESTANISLAO CHAPTER NO. 58

E CLAMPUS VITUS

GOLD DUST RECEIVER – P.O.  BOX 5136, MODESTO, CA 95352

 

The purpose of these questions is to determine if you are qualified to join the fellowship of Clampers.  Failure to properly answer the interrogation can result in your not being approved by the Greybeards as being fit for membership.  Answer all questions seriously and with forethought.  The E Clampus Vitus is a historic society that is dedicated to preserving California history and in the process of doing so, enjoy the camaraderie of our fellow man.  Consider well your answers.

 

PRINT CLEARLY!!                                                        Today’s Date ____________________

 

FULL NAME ______________________________________________________________________________

                                                Last                                        First                                        Middle

ADDRESS  ______________________________________________________________________________

                                                Street and Number

                     ______________________________________________________________________________

                                                City                                                        State                                                       Zip

PHONE NO.  (         )_____________________  (         )______________________

                                                               Work                                                           Home

NAME OF WIFE -_____________________________________________________________

(or next of kin)                                     Name                                                     Address

 

PLACE OF BIRTH _____________________________DATE OF BIRTH  ________________

                                    (Applicant under 21 years of age not accepted)

EMPLOYER  _________________________________________________________________

                                                                Name                                                     Address

 

Do you believe in our Supreme Patron, Saint Vitus? ______  Would you a sucker an even break?  ______________

Will you respect the authority under the silk hat?______   Will you temper the Sword of Justice with Mercy? _____

Will you use your Blunderbuss to protect the widow and the orphan?______________________________________

Reason for joining Clampers? _____________________________________________________________________

Contribution by you and your ancestors to California History? ___________________________________________

Do you have any physical disabilities that should be known to the Greybeards?__________________________

 

By virtue of filling out this form, placing my signature hereon, and tendering the required initiation fee, I have indicated that I have the desire to join the Ancient and Honorable Order of E Clampus Vitus, a male fraternal organization.  Furthermore, I verify that I am a male over 21 years of age, have an interest in California History and am sponsored by the (2) Active E Clampus Vitus members.

____________________

SIGNATURE OF CANDIDATE

PRINT CLEARLY 

 

SPONSORS (2) _________________________________      _____________________________________

                                                                Name                                                            Address          

                               ___________________        _________________________       _________________________

                                     Phone Number                          Date of Membership                             Sponsor’s Signature

                             _________________________________      _____________________________________

                                                                Name                                                     Address 

                               ___________________         _________________________        _________________________

                            Phone Number                          Date of Membership                              Sponsor’s Signature

 

 

Read and Sign the Next Page!

 

 

 

READ AND SIGN

 

  1. You are to notify the Greybeards and your sponsor in writing with your application of any known personal medical problems that could arise at the meeting.  This will help us be prepared in the event of a problem; it will not keep you from joining and will be held in confidence.
  2. Bring a complete change of clothing.
  3. It is recommended that you wear old duds or your sponsor’s costume that he may provide.
  4. You are a guest of your sponsor until the meeting is over; then you will be a Clamper, so don’t get drunk because you have to complete the initiation.
  5. $100.00 for sign-up on meeting day.
  6. Need valid ID for proof of age.

I understand the above. 

I, the undersigned, intending to be legally bound hereby, for myself, my heirs, executors, administrators and assigns, waive and release any and all rights and claims for damages I may have against Estanislao Chapter 58, E Clampus Vitus, Grand Council, and their or it’s officers, directors, trustees, subcommittees, agents, representatives, and members of the meeting.  I understand and agree that medical or other services rendered to me by or at the instance of any of the above parties is not an admission of liability to provide or continue to provide any such services and is not a waiver by any said parties of right hereafter. I understand that should I violate the Code of Clamper Conduct that I may be excluded from E Clampus Vitus.

 

Signature _____________________________   Date ________________________

 

P.B.C. FEE $75.00

 

 

GREYBEARDS USE ONLY

 

Accepted (Date) _________________________________

 

Rejected (Date)  _________________________________

 

Initiation Fee Received (Date)  _____________________

 

GNR’s Mark  ___________________________________

 

RETURN

 

Sorry, no online applications or reservations can be accepted. A separate signed release for each person attending and full payment must accompany each application form.