Membership Form
Legal name
First Name
Last Name
Preferred name (if different)
First Name
Last Name
Stage name
First Name
Last Name
Date of Birth:
Gender (statistical purposes only)
Male
Female
Non-Binary
Pronouns
He/Him/His
She/Her/Hers
They/Them/Theirs
Are you a former Monarch of the ISQCCBE?
Yes
No
Contact Information
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
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Algeria
American Samoa
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Anguilla
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Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
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Belgium
Belize
Benin
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Bhutan
Bolivia
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Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
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Canada
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Chad
Chile
China
Christmas Island
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Colombia
Comoros
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Cook Islands
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Cote d'Ivoire
Croatia
Cuba
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Faroe Islands
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The Gambia
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Gibraltar
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Guadeloupe
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Guinea
Guinea-Bissau
Guyana
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Hong Kong
Hungary
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India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
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South Korea
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Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
E-mail
Phone Number
-
Area Code
Phone Number
We would also like to know for statistical information.
Veteran status (enter branch)
Court and Dates:
Membership Options
Options
Individual Silver-Includes being listed in coronation program in 10pt font
Individual Gold-Includes name badge and being listed in coronation program in 12 pt font
Individual Platinum-
Household Silver-Includes all household members being listed in coronation program in 10pt font
Household Gold-Includes name badges and being listed in coronation program in 12pt font
Household Platinum-Includes name badges and being listed in coronation program in 14pt font
Pay here:
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Individual Membership-Silver level
$
15.00
Includes being listed in coronation program in 10pt font (if opted in)
Individual Membership-Gold Level
$
30.00
Includes name badge and being listed in coronation program in 12 pt font (if opted in)
Individual Membership-Platinum Level
$
50.00
Includes name badge and name in Coronation Program in 14pt font (if opted in)
Household Membership-Silver Level
$
30.00
includes name listed in Coronation Program in 10pt font (if opted in)
Household Membership-Gold Level
$
60.00
Includes name badges and being listed in the Coronation Program in 12pt font (if opted in)
Household Membership-Platinum Level
$
100.00
Includes name badges and names listed in Coronation Program in 14pt font (if opted in)
Additional Household Members
Legal Name
Date of Birth
Print Name in Coronation Program?
Name preference in Program
#1
Yes
No
#2
Yes
No
#3
Yes
No
#4
Yes
No
Names and Date of Births of Additional Household Members joining:
Signature
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