Trident International Windy City
3712 North Broadway PMB# 254
Chicago, IL 60613

www.trident-chicago.com          ChicagoTrident@aol.com

Application for Membership

Name: _____________________________________
Address: ____________________________________
City, State, Zip: ________________________________
Phone: ______________________                .     
Email: _________________________.     
DOB: _____________________.

Type of Membership:                _____ Full ($50, yearly)                  _____ Associate ($15, yearly)

Sponsor: _____________________________________________________________________________________

Please, list your club affiliations: ________________________________________________________________

___________________________________________________________________________________________

Please, list your hobbies/interests: _______________________________________________________________

___________________________________________________________________________________________

Please, list your character strengths: _____________________________________________________________

___________________________________________________________________________________________

Why is it your wish to join us? ___________________________________________________________________

____________________________________________________________________________________________

I, the undersigned, affirm that the above information is correct and that I am at least 21 years of age.

Signature: ____________________________________________________________________________________

========================      For Hall use only     =======================

__________  Accepted                              __________ Rejected                    
Date: ______________________________

Pledge Master: ________________________________________

Hall: __________________________________________________