APPLICATION FOR MEMBERSHIP

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 questions which are hereto attached.

TO BE A MEMBER YOU MUST BE A MALE OVER THE AGE OF 16, PRACTICING CATHOLIC AND BE OF IRISH HERITAGE BY BIRTH, DESCENT OR BE LEGALLY ADOPTED BY SUCH A PERSON AND BE OF GOOD MORAL CHARACTER. (Clergy do not need to be of Irish Ancestry)

LADIES INTERESTED IN JOINING, Please follow this link: JOIN THE LADIES A.O.H.

First Name:

Last Name:

Address:

Address 2:

City:

State:

ZIP Code:

Home Phone:

Cell Phone:

Work Phone:

Email:

Email: (please confirm)

Occupation:

Date of Birth: (MM/DD/YYYY)

Irish by ...

Are You Catholic?:

Name of Your Parish:

Have you made your First Communion? Yes No

Were you Confirmed in the Catholic Church? Yes No

Do you live your life in harmony with, and respect, the teaching of the Catholic Faith? Yes No

Do you belong to any Society to which the Catholic Church is opposed? Yes No

Were you ever previously a member of the Ancient Order of Hibernians? Yes No

Previous Division #, City, State and reason for withdrawal:

Do you have a specific division you would like to join? Yes No

Division Name, Number, Location and County:

Are you a Veteran? Yes No I am on active duty

Branch of Service: Army Navy Air Force Marines Coast Guard

I do solemnly pledge my sacred word and honor that my answers to the above questions are true.