04-26-2004 Special Called Meeting

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New Applicant APPLICATION FOR MEMBERSHIP Re-@nrolllmenOt ANNUAL DUES INCLUDES A SUBSCRIPTION TO EAGLE MAGAZINE PLEASE PRINT CLEARLY IN INK 1. Name ~ ~ ~ ~ ~ ~ ~} ~ ~ ~} ~} ~ I ~ U I ~ ~ ~ j ~} ~ ~ ~( ~ ~ ~ _~L~___l_J First MI Last 2. Date of Birth ~~ L~J ~~ Age u~ Email ~ i ~ ~ ~ ~ ~ } ~ ~ ~ ~ ~ I ~ ~ ~~ Month Day Year 3. Residence Address ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ } ~ ~ ~ ~ ~ } ~ ( ~ ~ ~ City } ~ ~ ~} ~} ~ ~ ~}} ~ ~} ~ StatelProv. ~U Zip Code ~ ~ ~ ~ L ~ - ~.~ Telephone W~ ~~~ - L_L~1~ Mailing Address (if diFferent) I ~ } ~ ~ } } ~ } ~ ~ ~ I ~ ~ } ~_ ~ ( } ~ ~ ~-1_~-~ If you have over been a member of this Order before, the following questions must be answered: State 4. I formerly belonged to Auxiliary No. ~U City } I ~ ~ ~ ~ ~ ~ ~ ~ I ~ ~ ~ ~ ~ IProv. L.~ 5. The reason for terminating my membership was 6. Have you ever applied For membership and were rejected? If yes, whereZ 7. Do you have male affiliation in the Fratemal Order of Eagles? ^ Yes ^ No IF yes, Name Relationship Aerie No. ~~ Having formed a favorable impression of your Auxiliary, I, being of sound body and mind, over eighteen years of age, believing in Cod, herewith present myself as a candidate for membership and if accepted, I promise to abide by and obey the Laws, Rules and Regulations of the Fraternal Order of Eagles. I declare that I have not been rejected by an instituted Auxiliary within the past six months nor do I stand suspended by any Auxiliary of the Fraternal Order of Eagles. I agree that my answers to the questions are true and are without any omissions. It is further agreed that in the event of my failure to pay my dues to the Order on or before date due, all benefits hereunder shall cease according to the Rules and Regulations of the Fraternal Order of Eagles, and the local Auxiliary By-laws. Funeral benefits requirements are that you must be initiated before passing your fifq•-fifth birthda}•, and the benefits are not effeMive until twelve months following initiation. I understand that if I do not appear for initiation within six months after my election to membership, my initiation fee will be forfeited and my application for membership cancelled. The initiation fee must be sent in to Grand Aerie immediately. I fully agree that the Auxiliary shall not be required to pay me any benefits unless approved by the Grand Aerie and by the local Auxiliary By-laws. Applicant's Signature ;Date n ~e~ F E rq mt `~~'~, y M ',~ aa~`~ 'lU~e~c `~,,," You Have Fun . fie ~iA`~ ..Helping ®thers APPLICATION FEES AND ANNUAL DUES ARE NOT TAX DEDUCTIBLE Form No. MEM-217-X OfRcial Application (Continue on Reverse Side -OVER)