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Elks 994 Update Info
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* Indicates required question
Full Name
*
Your answer
Birthdate
MM
/
DD
/
YYYY
Cell Phone (xxx-xxx-xxxx)
Your answer
Receive Text Updates?
Yes
No
Clear selection
Home Phone (xxx-xxx-xxxx)
[Use cell phone if no land line]
*
Your answer
Work Phone (xxx-xxx-xxxx)
Your answer
Email
Your answer
Alternate Email
Your answer
Street Address
*
Your answer
Apartment
Your answer
City
*
Your answer
State
*
Your answer
Zip (xxxxx-xxxx)
*
Your answer
Alternate Address - Street
Your answer
Alternate Address - Apartment
Your answer
Alternate Address - City
Your answer
Alternate Address - State
Your answer
Alternate Address - Zip (xxxxx-xxxx)
Your answer
Conditions for Alternate Address Use
Your answer
Spouse Full Name
Your answer
Spouse Birthday
MM
/
DD
/
YYYY
Anniversary
MM
/
DD
/
YYYY
In Case of Emergency - Name
Your answer
In Case of Emergency - Relationship
Your answer
In Case of Emergency - Phone (xxx-xxx-xxxx)
Your answer
Former Elk Roles (PER, PDDGER, etc)
Your answer
Veteran?
Yes
No
Clear selection
If Veteran - Branch
Army
Navy
Marines
Air Force
Coast Guard
National Guard
Reserves
Clear selection
If Veteran - Discharge Type
Active
Honorable
General
Other Than Honorable
Bad Contact
Dishonorable
Entry-Level Separation
Medical Separation
Separation for Convenience
Clear selection
If Veteran - Discharge Date
MM
/
DD
/
YYYY
Committees/Activities You Are Interested In
Auditing & Accounting Committee
Activities Committee
Fraternal Committee
Accident Prevention Subcommittee
Public Relations Committee
Soccer Shoot
Hoop Shoot
Veteran's Services
Flag Day
Hunters Fest
Golf Tournament
Bartending/Wait Staff (volunteer)
Youth Activities
Easter Egg Hunt
Drug Awareness
Membership Subcommittee
Memorial Day Subcommittee
State Major Projects Subcommittee
Other:
What else would you like us to know?
Your answer
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