Laserfiche WebLink
It9ew dlppiot®ee4 <br />ANNUAL DUES INCLUDES A SUBSCRIPTION TO EAGLE MAGAZINE <br />PLEASE P131NT CLEARLY IN INK <br />1. Name 1 1 1 1 1 1 I I I I I I l l '~ I I~ I I I I I I I I I; J <br />First MI Last Suffix <br />2. Date of Birth ~L_J L__ I __ L_1_ ! Age ~__ ~ ~ Email L~_~___ 1 _ _ I _~. L_i. _ ._ I .. I .. __ _ I . I I <br />Month Day Year <br />3. Residence Address L~ .___ _1__1~J-`1~.___~___L_' _ l_ 1 _..__ _ !. __ ~ _.L. _!. 1__ ~ 1. _J <br />City I I I I I I I I I I I State/Prow. L_1__~ <br />Zip Code ~ ~ I I I I - ;~~ Telephone i.~.~ J ~L-! - _._ 1~I_~ <br />Mailing Address (iF diFFerent) I I ~ _L_~ ~ ~ ~__ __I_~~__~___ ~ _~_._.~_.~__ _ __1_ <br />Bf you have ever been a member of this Order before, the following questions Ilnust be answered: <br />State <br />4. I formerly belonged to Aerie No. j__1__LJ_ City I I I I I I I ~_ 1_ .~ IProv...__ <br />5. The reason for terminating my membership was <br />6. Have you ever applied for membership and were rejected? If yes, where? <br />TO THE OFFICERS AND MEMBERS: <br />I being of sound body and mind, and believing in the existence of a Supreme Being, herewith resent myself as a candidate for membership, <br />and if accepted, I promise to abide by and obey the Laws, Rules and Regulations of the Fraternal ~rder of FYogles. I declare that I have not been <br />rejected by an instituted Aerie within the past six months nor do I stand suspended by any Aerie of the Fraternal Order of Eagles. <br />I further understand that until this application for membership is approved, accepted, and I am initiated, I shall not be entitled to benefits of <br />any kind in accordance with the laws of the Order. <br />1 understand that if I do not a pear for initiation within six (6) months after my notice of election to membership, my initiation fee will be forfeited, <br />and my a plication for membership cancelled. <br />I certify that I have read carefully all the Foregoing conditions, and that my answers on this application are true and correct. I also agree that <br />in the event of my Failure to pay my dues to the Order on or before the date due, my membership in the Order shall cease according to the Consititution <br />and Statutes of the Fraternal Order of Eagles. <br />Applicant's Signature <br />Date <br />Y® t$kE F16fs1:~ Iltl 8T StEtG6`dI1TpRY <br />Application No. I I I I I I I I I In Aerie No. ~ I I I I Fraternal Order of Eagles <br />Date Reported to Month Day Year <br />Amount Paid $ I I I I I I Official Receipt No. I I I I I G.A. Mem. Dept. L1J L1J L1J <br />~®-~aorr®~Blrnoenlr <br />APPLICATION FEES AND ANNUAL DUES ARE NOT TAX DEDUCTIBLE <br />Form No. MEM-101-A/98 Official Appliwfion (Confinue on Reverse Side -OVER( <br />