View Only (Sample) Application
Odd Fellows and Rebekahs
UNITED NATIONS PILGRIMAGE FOR YOUTH
Application for Adult Leaders |
Current Photo
|
|
|
| Full Name: |
_____________________________________________________________ |
| Date of Birth: |
_____________________________________________________________ |
| Address: |
_____________________________________________________________ |
City, State/Province
: |
_____________________ / ________ Zip/Postal Code: _______________ |
| Phone / Cell Phone: : |
___________________________ / ________________________________ |
| Email: |
____________________________________________________________ |
| Marital Status: |
M-S-D-W Children:Y-N How many?: _____________ |
| Present Occupation: |
____________________________________________________________ |
| Order Affiliation: |
Odd Fellow __ Rebekah __ TR __ Jr.OF __ # of Years __________ |
| |
|
| Youth Work (Order related):___________________________________________________________________________ |
| Other Youth Leadership Experience:_____________________________________________________________________ |
| Other related activities and interests: _____________________________________________________________________ |
| Skills that may be helpful in the Program (music, drama, etc.): __________________________________________________ |
| Other helpful information: _____________________________________________________________________________ |
| |
_____________________________________________________________________________ |
| |
: |
|
| Applicant signature: ________________________________________________________ Date: _____________________ |
| |
| Physician’s Statement: |
| The Applicant was examined in my office on (mm/dd/yyyy) ___________
and found to be in good physical condition. |
| Limiting Conditions: _________________________________________________________________________________ |
| Physician's Signature: ________________________________________________________________________________ |
| Address: _________________________________________________________________________________________ |
| |
| Application approved by: |
| The Jurisdictional UNP Committee |
Jurisdiction: _________________________________ |
| _____________________________________ |
____________________________________________________ |
| _____________________________________ |
____________________________________________________ |
| |
|
| Grand Master: ____________________________________________________________________ |
| |
| Rebekah Assembly President: ________________________________________________________ |
| |
to download a Tour Leader Application (MS Word).