ANCIENT ORDER OF HIBERNIANS IN AMERICA, INC.
I hereby apply for admission into the Ancient Order of Hibernians in
America, Inc., and agree that my reception and continuance in said Order
shall depend on the truthfulness of my answers to the following questions
which are made by me for the purpose of gaining admittance to the order.
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My Name is __________________________ Age ________ Birthday
M/D/YR _____________
Are you Irish by birth or descent ?_________ Are you a Roman Catholic
?____________
Are you divorced ? ____________
Have you complied with your religious duties ?______
Name of your Parish or Church?_________________________________
Do you belong to any society to which the Catholic Church is
opposed?______________________________________________
Were you ever a member of the A.O.H., if so, in what City and State? )
_____________________________________________
What was your previous membership number? (if available)
___________________________________
What was the reason for your withdrawal?
_____________________________________________________________________
Your Current Residence
Street _______________________________________________________________
City ____________________________ State _____ Zip
Code _____________
Home Phone # _______________________________
Home E-Mail Address ____________________________________
Occupation _______________________________
Are You Self-Employed Yes ____ No ___
If yes, your business name ____________________________ OR your
employer______________________________________
Business Address City ______________________ State _____ Zip Code
_________
Business Phone # ______________________________
Business E-Mail Address _____________________________________
I do solemnly pledge my sacred word and honor that the answers I have
given to the above questions are true.
Signed_____________________________________ and dated this _____day of
_____________ in the year ________.
PROPOSER'S CERTIFICATE: I hereby certify on my honor as a member of the
Ancient Order of Hibernians, Inc. that I am acquainted with the above
applicant, and know him to be a practical Catholic, and one worthy in every
way to become a member of this Order.
Signature __________________________
Print Name _____________________________
An application fee of $30.00 must accompany
this application. Checks should be made payable to the Ancient Order of
Hibernians.
DATE PAID ___________ CASH ___ CHECK # ________ CHECK DATE ___________
Division Readings:1st Date_______ , 2nd Date________,
Shamrock Degree Date _______, Major Degree Date______________
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Standing Committee: Respectfully reports that we have investigated the
qualifications of said applicant for membership in the Order and
recommend him for said membership. Signature
______________________________ Date ___________
Financial Secretary: I hereby certify that the initiation fee of
$________ has been paid on the Date _______________
Signature ______________________________ Date
______________________________
President's Certificate: I hereby certify that this application has
been read to me at a regular meeting and that the applicant has been
elected by the membership of this division on this _____day of
_____________ in the year ________.
Signature ______________________________
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