INTERNATIONAL ORDER OF
THE KING'S DAUGHTERS AND SONS

Chautauqua, New York
August 20 - August 24, 2011

PLEASE PRINT
Applicant's Name: ___________________________________________

Address: _______________________________________________________________

____________________________________________________________Zip:_______

Birthday (month and day): _________________

Phone: (____) _____________ E-Mail: _____________________

Branch: ________________________ Circle: ______________________

Number of years you have been a member: _____________

Positions you have held in

Circle: _____________________________________________________________________

City Union/District: ____________________________________________________________

Branch: _____________________________________________________________________

Are you your Branch or Circle Membership Chairperson? ____________

Is there anything that would limit your climbing two or three flights of stairs and walking up and down hills?

____________________________________________________________________________

Please indicate your willingness to participate in the following:

1. I am willing to give an oral report about my New Horizons experiences at the next Branch
convention. ______
2. I am willing to share my experiences with Circles in my Branch. _____
3. I am willing to write an article for my Branch newsletter. _____
4. I am willing to share ideas and help implement plans for the future of our The KDS. _____
5. I know that I must be prepared to share a brief (5 minute) Bible meditation at New Horizons. _______
6. I know that I must present a three (3) minute informative talk about the work of my Branch. (If more than one person from your Branch is participating, please do this together.) ______
7. I understand that I will be rooming with a member from another Circle or Branch and I will have to share a bathroom with other members. ______
8. I understand there is a parking fee of about $7.00 per day for my vehicle._____

Please attach a separate sheet of paper on which you have TYPED OR NEATLY WRITTEN a paragraph explaining why you would like to participate in the New Horizons 2011 Program and how you would use your experiences to help your Circle, Branch, and International grow.

Applicant's Signature: ______________________________

Branch President's Signature: ________________________

*** (This application will not be processed without the Branch President's signature.)

The completed application must be received by the New Horizons Chairperson by May 16, 2011.

The Branch President must forward the completed application to :

Janet Laude
128 Hamilton Street
Indiana, PA 15701
724-465-2208
janlaude@comcast.net

or

Lee Anne Bruner
1750 S. Taft Avenue
Evansville, IN 47714
812-491-6080
labruner@wowway.com

.................................................................................................

To be completed by New Horizons Chairman

Date application received: ______________

Date application approved: ______________ Application not approved: _________

Acceptance acknowledged: ___________________