Application For Membership

Please fill out and press print. Each application must have two Proposers (members of the Order) to be considered. The application should be delivered in person as to be welcomed in to the family properly. Thank you for wanting to be come a member and do something great!

New Application Auxiliary(Male)
Re-Enrolled Application Aerie(Female)
Full Name:
Date of birth:
Age:
Residence Address:
City:
State/Prov.:
Zip:
Telephone:
Email:
Mailing address:
Have you ever applied for
membership and were rejected?
YesNo
If yes where?
Have you ever been convicted
of a felony? (WI, HI, Canada excluded)
YesNo
Are you a:


If you have ever been a member of this Order before, the following questions must be answered.

I formerly belonged to Aerie/Aux. No. City: State/Prov.
The reason for terminating my membership was:
First Proposer: Second Proposer:
Name:
Name:
Grand Aerie I.D.:
Grand Aerie I.D.:
Address:
Address: