Free Sample Membership Application Form

Membership Application forms are used by organizations who desire to screen prospective members. This application includes all relevant applicant information (i.e., name, social security number and employment status), information about the applicant's spouse and children, and personal references. The Membership Application also requests that the applicant provide emergency contact information.

Disclaimer:This was not drafted by an attorney & should not be used as a legal document.

Membership Application
Date: __________________                                                                          Membership No. ___


Applicant Information:

Name:                          ___________________________      ________________________

(First, Middle, Last)                            (Maiden Name – if applicable)


D.O.B.: __________________                                  SSN: ________________________

Present Address:         _____________________________________________      ___________

(No., Street, City, State & Zip)                                              How Long?

Previous Address 1:    _____________________________________________      ___________

(No., Street, City, State & Zip)                                              How Long?

Hm. Phone No.: _________________           Wk. No. ____________________

Mobile No.: ____________________            Email Address: __________________

Marital Status? _______         Spouse Information:   ____________________________________

(Name and Address (if different than above)

No. of dependants (minor children): ________

Dependent Information

Name: ______________________                 Relationship: ____________  Age: _____

Emergency Contact:   _________________________________     ______________

(Name and Contact information)                    (Relationship)

Employment Information:

Name of Present Employer:                _______________________________________________

Address of Present Employer:            _______________________________________________

(No., Street, City, State & Zip)

Position/Title:  _________________              Salary: __________ per  __ month __  year


Name              Address                      Phone No.                  Relationship               Years Known



Applicant’s Signature



Applicant’s Printed Name




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