Illinois Falconer's Organization

Application for Membership

Complete this form to request membership in the Illinois Falconer's Organization. Failure to complete any section listed with a * will result in an invalid application that will not be processed.
*Name * First Last
*Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
*Home Phone (Be sure to use correct format, no ( ) spaces hyphens etc) *

**IMPORTANT** Be sure to use correct format, no ( ) spaces hyphens etc
Cell Phone (Be sure to use correct format, no ( ) spaces hyphens etc)

**IMPORTANT** Be sure to use correct format, no ( ) spaces hyphens etc
Business Phone (Be sure to use correct format, no ( ) spaces hyphens etc)

**IMPORTANT** Be sure to use correct format, no ( ) spaces hyphens etc
*Email *
*Please state your current falconry license status: * Not Currently Licensed Apprentice Class Falconer General Class Falconer Master Class Falconer
If Applying for Regular, voting membership, please provide your Illinois Falconry permit #:
Check all current raptor related licenses you possess: Falconry Rehabillitation Education Propagation Eagle Falconry
*Check which type of Membership you are requesting. Regular membership requires the applicant possess a current Illinois Falconry permit and is a minimum 18 years of age. Associate membership is open to anyone provided they are at least the minimum legal IL apprentice age minus one year. Affiliate membership is for falconry, hunting and raptor focused organizations. * Regular (Licensed Illinois Falconer) Associate Affilate Organization
*Birthdate (Be sure to use correct format) * / MM / DD YYYY
**IMPORTANT** Be sure to use correct format
*Current Illinois Falconer's Organization Reference #1 (His or Her Name) NOTE: please follow up with your reference to insure they respond. An email verification will be sent to them as soon as you submit this form. Your application will not be processed until they respond.
*Email contact of your 1st reference member for admission (will be verified by submitting this application to referenced member)
*Have you ever been charged or convicted, plead guilty, nolo contendere to a wildlife, hunting,or falconry violation? (failure to answer honestly results in being barred from the organization) If you decline to answer you may apply as an associate member but will be ineligible for regular, voting membership.
Please list any falconry, wildlife or hunting organizations to which you belong:
*Please include a brief bio, telling about yourself and your longtime or relatively new interest / involvement in falconry. This is required and is especially important in the event you do not have a reference to list. *
By submitting this form you solemly agree that all answers are truthful and accurate. Any misrepresentation of facts used to obtain Regular, voting membership status on this form will result in permenant ineligibilty to be a member of the Illinois Falconer's Organization.

Illinois Falconer's Organization

Illinois Falconer's Organization

Complete this form to request membership in the Illinois Falconer's Organization. Failure to complete any section listed with a * will result in an invalid application that will not be processed.

By submitting this form you solemly agree that all answers are truthful and accurate. Any misrepresentation of facts used to obtain Regular, voting membership status on this form will result in permenant ineligibilty to be a member of the Illinois Falconer's Organization.