Mid Rivers Chapter Application

Membership Application

Thank you for your interest in joining Mid Rivers 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 midrivers@modemolay.org.
Thank you for your interest in joining Mid Rivers 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 midrivers@modemolay.org.

Before being invited to join, the members of the Chapter must vote in the affirmative to elect you to the membership.
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 Enrolled School
Applicant Signature
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 Mid Rivers Chapter of DeMolay International.
Parent/Guardian Signature
Referral Information

We'd love to know where you heard about our Chapter.
How did you hear about Mid Rivers Chapter?

Other
Referring Member Name

First NameLast Name
Joining Fee Information
The joining fee for Mid Rivers Chapter is $100, however, we are discounting this fee for our Charter Members to only $50. The joining fee is due upon application to the Chapter.

Annually, on January 1st, our members are assessed $50 for an activity fee.

Financial aid may be available on a need basis. Please contact us at midrivers@modemolay.org for assistance if needed.
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 Mid Rivers Chapter of DeMolay International. Please allow 48-72 hours for a response to this application.
Should be Empty:

Membership Application

Applicant Information

Parent/Guardian Information

Referral Information

Joining Fee Information

Joining Fee Payment

Payment Methods

Submission