ANCIENT ORDER OF HIBERNIANS

Major Tommy McGuire Division #1

Burlington County, New Jersey

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?_________________________________

Where 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 ___________________________________________________________

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 _____________________________