Become a Member – Gold Shield Foundation

You may use the form below to complete your application online or opt to download, print & mail in your application with your initiation fee.

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Spouse's Name
First Last
Business Affiliation
Company Name
Title
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Initiation Fee & Annual Dues
- Please send me an invoice for my initiation fee.
- I will mail a check for my initiation fee.
I understand that based on my decision above, I will be invoiced or will mail in a check for my $200 initiation fee to complete my application. By signing below, I understand that hereafter my dues are $200 annually. The Foundation’s Federal Tax Exempt ID# is 59-2236362.
Name of sponsoring member supporting this application
I agree & understand that I will not use this membership, if granted, to obtain favors in connection with the violation of any law or ordinance.
Date
Name
This field is for validation purposes and should be left unchanged.

Business Affiliation