Membership Application

Thank you for your interest in applying for membership to Le Club Calumet. Prior to starting this application, please have ready for upload, certified birth certificates for yourself, your father, mother, each fraternal grandparent, and each maternal grandparent.

Le CLUB CALUMET - MEMBERSHIP APPLICATION

334 West River Road, Augusta, Maine 04330
Phone: (207) 623-8211 - Fax: (207) 623-3360 - Email: events@calumetclub.com

Please complete all requested information in the upper portion of this application. Failure to provide complete and accurate information may be cause for rejection or expulsion. Information in this section is used to determine your eligibility and is kept confidential.

Name of Applicant(*)

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Physical Address(*)

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Mailing Address

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City/Town(*)

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State(*)

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Zip(*)

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Date of Birth(*)

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Email Address(*)

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Home Phone

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Cellular

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Business Phone

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Are you a U.S. Citizen?

Yes

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Are you a Franco-American

Yes

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Are either of your parents or grandparents of Franco-American origin?

Yes

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Paternal

Father's Full Name

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Grandfather's Full Name

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Grandmother's Maiden Name

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Maternal

Mother's Full Maiden Name

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Grandfather's Full Name

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Grandmother's Maiden Name

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Occasionally family names have been changed and no longer resemble the "known" French name. If this is the case with this application, you must supply the membership committee with pertinent genealogical information to prove the French lineage. Failure to produce this information may affect your eligibility.

Felony Conviction?

Yes

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Dishonorable Discharge (Military)

Yes

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If yes to either questions, please specify the type of felony or the type of discharge.

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What is your occupation?

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Can you speak French?

Yes

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Understand French?

Yes

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Read French?

Yes

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Write French?

Yes

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Briefly describe what you have to offer to Le Club Calumet should you become a member.

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If the Club needed your help, what are the best times during the week or weekend that you could volunteer your assistance to the Club?

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