Clinton Chapter Application

Clinton Chapter Membership Application

Thank you for your interest in joining Clinton Chapter of DeMolay International. Please complete this form and a representative will contact you with information about our next joining opportunity. Should you have any questions, please reach out to us via email at clinton@modemolay.org.
Applicant Information

This section is for the young man interested in joining our Chapter.
Applicant First & Last Name*

First NameLast Name
Applicant Middle Name*
Applicant Name Suffix
Applicant Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Cell Number (if applicable)
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Email Address (if applicable)
example@example.com
Applicant Birth Date*

MonthDayYear
Date
Applicant Shirt Size*
Applicant Current Grade in School*
Applicant Signature

Clear
Parent/Guardian Information

This section is for the young man's parent/guardian(s).
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address*
example@example.com
By siging below, you agree to your son joining Clinton Chapter of DeMolay International.
Parent/Guardian Signature*

Clear
Referral Information

We'd love to know where you heard about our Chapter.
Clinton Chapter MemberFamily MemberCommunity EventAdvertisementOther
Referring Member Name

First NameLast Name
Joining Fee Information
The joining fee for Clinton Chapter is $50. The joining fee is due upon application to the Chapter.
Joining Fee Amount*
Optional Donation to Chapter
Total Fee*

Joining Fee Payment

USDTotal Fee

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Submission

By submitting this application, you agree to share your information and intent to apply for membership with Clinton Chapter of DeMolay International. Please allow 48-72 hours for a response to this application.
Should be Empty:

Clinton Chapter Membership Application

Applicant Information

Parent/Guardian Information

Referral Information

Joining Fee Information

Payment Methods

Submission