NEW MEMBER APPLICATION

Greetings! GLOSS is delighted and thankful to have captured your interest!!

Below is the online portion of the GLOSS membership application process. After receiving notification of its completion, one of our volunteers will follow up with the applicant to schedule the second step of the membership application process—a video conference interview with both the applicant and applicant's parent(s).

The final step is to submit the one-time new member enrollment fee ($100). Please complete this form and one of our volunteers will get back to you shortly.

If you have questions, you may contact us at GLOSSmembership@gmail.com.

Which local GLOSS Chapter will you be joining?

PROSPECTIVE MEMBER'S CONTACT INFORMATION

Name

First Name

Last Name

Mobile Number

(###)

###

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Home Phone

(###)

###

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

County

ABOUT THE PROSPECTIVE MEMBER'S

How did you hear about GLOSS?

Referral from Volunteer or Member

Instagram

Facebook

Twitter

Other

If you chose 'Other' for the previous question please describe.

Age

Date of Birth

T-Shirt Size

School/College

Grade/College Year

Place of Employment/Service

Place of Worship/Church

Is the applicant willing to accept only God's best for her life?

Is the applicant willing to obey Biblical truths?

PROSPECTIVE MEMBER'S PARENT OR LEGAL GUARDIAN INFORMATION

Mother's/Legal Guardian's Full Name

First Name

Last Name

Mother/ Legal Guardian Email

Mother/ Legal Guardian Phone Number

(###)

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Father's/Legal Guardian's Full Name

First Name

Last Name

Father/Legal Guardian Email

Father/Legal Guardian Phone Number

(###)

###

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Please fill out the next section, if you would like to add an additional emergency contact.

EMERGENCY CONTACT

Emergency Contact Name

First Name

Last Name

Relationship to Applicant

Emergency Contact Email

Emergency Contact Phone Number

(###)

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