Membership Form KEGITES CLUB INT'L (US ARCHAIVARIAN) — For existing Kegites members relocating to the United States Full Name * Enter your full name, starting with FIRST NAME Email Address * Phone Number * Profession / Business / Occupation * Birthday (Month & Day) * 🎂 Month January February March April May June July August September October November December / Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 State of Residence * — Select your state — Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Convergence * Select the convergence in the state where you live. If none, select N/A. — Select convergence — DMV Convergence, Maryland Garden State Convergence, New Jersey Land of Lincoln Convergence, Illinois Raceway Convergence, Indiana Texas Convergence, Texas N/A Ilya * If you do not have an ilya, enter N/A Keg Year * e.g. 2007/2008 Portfolio * Select your current portfolio Chief Life Senior Fellow (LSF) Senior Fellow (SF) Fellow If you selected LSF — which Chief (or Council of Chiefs) elevated you, and in what year? * Honorary Portfolio Optional — all portfolios are subject to verification. Leave unselected if you do not have any. Patron Matron Grand Patron Grand Matron Eternal Grand Patron Eternal Grand Matron Recent Photograph * Upload a recent photograph (JPG, PNG — max 10 MB) I clearly understand and agree that my membership is contingent upon my financial obligations. I hereby commit to the full and immediate payment of 100% of my annual dues. I understand that this payment is a mandatory prerequisite for my membership as a US Archaivarian and must be settled in full to maintain my standing and support the club's administrative and developmental goals. Note: Your annual dues begin counting from the month your application is approved and you are added as a US Archaivarian member. Dues can be paid via Zelle to payment@usarchaivarian.org. I Accept the above terms * Submit Application