BSEC Membership
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Full Legal Address *
Current residence, if different from above:
Phone Number ( Home)
Phone Number (Cell) *
Email Address *
Date of birth *
Are other family members applying as well? Please add their name, email and date of birth here:
Your preferred means of contact: *
Required
Emergency contact, their relationship to you, email and phone number (They would be contacted in case of emergency only): *
Do you have children? Please list names and ages below:
Have you been a member of BSEC before? If so, when? *
Are other family members or friends members of BSEC? If so, please list their names.
Tell us a bit about yourself. Are there any interests, work background or skills you would like to share? *
What interests you? Checks all that apply and add, if necessary.a. The Platformsb. Politics, the American dramac. American history, including the forgotten history of other peoplesd. Socializing with other memberse. Sharing and discussing booksf. Companionship
Do you wish to increase you knowledge of particular topics? Share them with us:
Anything else you would like us to know?
Are you currently part of any activities at BSEC? If so, which ones? *
Are you aware of these committees and their work? Affirm by checking all that apply.
If you like to join any of the committees above, please identify it/them here:
Have you ever attended an orientation/new member supper? If so, how many and how long ago? Would you be interested in participating in these in the future?
Would you like to be mentored by one of our members? *
Are there any programs/small groups that you would like to see added?
BSEC relies on the contributions of its members.  The minimum annual pledge is $300. It can be paid monthly. No-one is turned away for lack of funds.  If this creates a hardship, alternatives can be provided.  What is your annual pledge? *
Anything else you would like to share with us?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms