Aerie Membership Application

Application Type:*

NewRe-enrollDual ApplicantTransfer

Former/Current Aerie Name & Number

Name*

Middle Initial

Mailing Address *

State*

City*

Zip*

Date of Birth*

Date

Home Phone*

Cell Phone

Please enter a valid phone number.

Email

example@example.com

Occupation

Marital Status*

MarriedSingle

Spouse's Name (if applicable)

Number of Children under 21 years of age*

Dual/Transfer Applicant Information

(If you are applying for dual membership or transfer, this field MUST be filled)

GAID #

Aerie #

Re-Enrolled Membership Information:

I understand and acknowledge that by re-enrolling in the Fraternal Order of Eagles, I may lose all prior years of membership in the Fraternity, which may affect my qualifications for Life Membership, Golden Age Eagle, and for residence in Eagle Village.

(MUST BE SIGNED BY RE-ENROLL APPLICANT)

Signature of Re Enrollee

Proposer Information

All New and Re-Enroll Applicants must be proposed by two (2) Aerie Members of the Order in Good Standing. All information must be completed below.

Name*

Middle Initial

Address

City*

St. /Prov.*

Zip

Proposer's Email (required to allow proposer to sign form online)*

example@example.com

GAID #

I certify that the above proposer details are correct (fill in or correct any missing fields)

Signature

Name

Address

City

Zip

GAID #

Signature

I hereby certify that I profess to be of good moral character, and believe in the existence of a Supreme Being, I am not a member in any other Aerie or Auxiliary within the Order (unless applying for dual or transfer membership), I am over twenty-one (21) years of age, unless the By-Laws of this Local Aerie allow for those between the age of eighteen (18) and twenty-one (21) years of age to apply. I am not in any way connected or affiliated with the Communist Party, or believe in or advocate the overthrow of the government of this country by force or violence. I understand that the use of the social quarters of any Aerie of the F.O.E. shall be in confor- mity with the House Rules of that Aerie. I understand that my membership in this Aerie is conditioned on a favorable vote of the membership, and if rejected, I cannot apply for membership in any Aerie or Auxiliary until twelve (12) months have passed. I certify that the information I have provided is true and that no omission or concealment of information has been made of any fact or circumstance. I freely and without reservation accept and honor this Certification of Membership.

Please answer the following questions: have been rejected for membership in an Aerie or Auxiliary:

I have been rejected for membership in an Aerie or Auxiliary:*

YesNo

If yes, date:

Date

I was previously a member of an FOE Auxiliary.*

YesNo

If yes, I have resigned my Auxiliary membership AND waited 12 months before applying for Aerie Membership?

YesNo

I am a convicted felon?*

YesNo

I am a registered sex offender?*

YesNo

Signature*

Printed Name*

Signature Date*

Date

AERIE APPLICANT INFORMATION