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:

Active Military
Military Veteran
Police Officer
Fire Fighter

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: