ORDRE MONDIAL DES GOURMETS DEGUSTATEURS Confrérìe
de la Chaîne des Rôtìsseurs
Chaine House
at Fairleigh Dickinson University
285 Madison
Avenue
Madison, NJ
07940-1099
Phone:
(973) 360-9200 Fax: (973)
360-9330
APPLICATION FOR MEMBERSHIP
(Please Type or print
clearly)
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Date:_________________ Bailliage de Greater Ft. Lauderdale
__ Miss __ Ms. __ Mrs. __ Dr. __ Mr.
Name:
________________________________________________________________
LAST
FIRST MIDDLE
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Check one where mail should be sent:
__ Home Address: ______________________________________________________
City, State, Zip: _____________________________ Phone: ( )________________
Fax: ( )________________
__ Name of Firm: ___________________________ Position: ____________________
Type or Nature of Business: _______________________________________________
Address: ______________________________________________________________
City, State, Zip: _____________________________ Phone:( )_________________
Fax: ( )_________________
Date of Birth: ______________________ Place of Birth _________________________
Citizen of: ________________________ First Name of Spouse ___________________
Is Spouse a Member of Ordre? ______________________________________________
Wine or Gastronomic Societies to which you
belong: _____________________________
________________________________________________________________________
Why do you wish to join Ordre Mondial?
______________________________________
________________________________________________________________________
Have you a turning Spit of Rotisserie? _______ Grill? _______ Wine Cellar? __________
Do you have a wine cellar? ______________
If yes, please describe: ________________
________________________________________________________________________
________________________________________________________________________
Are you a professional in the wine and/or
spirits industry? _________ If yes, please
describe your professional capacity:
___________________________________________
________________________________________________________________________
________________________________________________________________________
If you are not involved in the wine and/or
spirits industry as a full-time occupation, please
summarize below the extent of your knowledge
of wine and/or spirits which you feel would
qualify you as a member of Ordre Mondial:
_____________________________________
________________________________________________________________________
________________________________________________________________________
Have you ever been a Member of Ordre Mondial? ______ Where and When?___________
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_______________________________________________________________________
Signature of
Applicant
Date
_______________________________________________________________________
Signature and rank of Sponsor (Must be a
Member of Ordre Mondial) Date
_______________________________________________________________________
Approved (Bailli, Regional or National
Officer of Ordre Mondial) Date
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Your check must accompany this Application.
INITIATION FEE
(Includes Decoration and Certificate awarded
at $ 60.00
.
Formal Induction Ceremony )
NATIONAL ANNUAL MEMBERSHIP FEE $ 35.00 .
TOTAL FEES PAYABLE TO "CHAINE DES
ROTISSEURS"
(check for total should be made out to the La
Chaine Des Rotisseurs) $ 95.00
.
LOCAL DUES MADE PAYABLE TO CHAINE
DES ROTISSEURS, BAILLIAGE DE FT.
LAUDERDALE $ 25.00
.
(Forward with application, proxy
declaration, and both checks to
Chaine des Rotisseurs, Bailliage de
Greater Ft. Lauderdale,
Heidi A. Rosenthal 10381 Golden Eagle
Court, Plantation, Fl 33324)
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FOR NATIONAL USE ONLY: Date Rec._______
Date to Paris: _______ RFD:________
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PROXY DECLARATION
ORDRE MONDIAL DES
GOURMETS DEGUSTATEURS
The undersigned (whose name appears
herein below), hereby certifies that he/she is a member
in good standing of the ORDRE MONDIAL DES
GOURMETS DEGUSTATEURS and does
hereby constitute and appoint BURTON H.
HOBSON in his/her name and stead as his/her
Proxy to attend all Special and Regular
Meetings of the General Assembly (and any advancement
or adjournment thereof); and, thereat to cast
the vote(s) which the undersigned would be entitled
to cast (if present) on all matters submitted
to the General Assembly to be voted upon.
Further, the undersigned authorizes and
appoints said proxy to substitute any other person(s) to act
hereunder; to revoke any such substitution;
and, to be counted for purposes of quorum. This proxy
Declaration may be revoked by the undersigned
electing to personally vote at any such Meeting or
at anytime in writing filed with the National
Administrative Office. In the event that BURTON H.
HOBSON shall be incapacitated or otherwise
unable to act, JOSEPH M. GIRARD shall
automatically succeed in his place and stead as
________________________________
Proxy during said period of incapacity or inability
(Member's Name - Please
Print) to act. Photocopies of this executed Proxy
Declaration shall be deemed as the original thereof
_________________________________
for all purposes. This Proxy power may be
(Baillage/Chapter) delegated by the holder.
Executed and effective as of
TO BE COMPLETED, SIGNED AND
_______________________ 19 ________
RETURNED WITH APPLICATION
___________________________________
(Member's Signature)
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