Auxiliary Application Form

WHO WE ARE
AUXILIARY APPLICANT INFORMATION
Please Print ALL Information Must be Completed

*ALL New and Re-Enroll Applicants must be proposed by two (2) Auxiliary Members of the Order in Good Standing ALL information must be completed below.
Application Type

NewRe-EnrollDual ApplicantTransfer
CURRENT/FORMER AUXILIARY
Name
Middle Initial
Mailing Address
City
State
Zip
Date of Birth

MonthDayYear
Date
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email
example@example.com
Occupation
Marital Status

MarriedSingle
Spouse's Name
Number of Children under 21 years of age
AUXILIARY RE-ENROLLED MEMBER INFORMATION
I understand and acknowledge that by re-enrolling in the Fraternal Order of Eagles, 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

Clear
Previous Auxiliary Name
Location
Number:
Our latest achievement, the Fraternal Order of Eagles Diabetes Research Center at the University of Iowa, opened its doors in 2014 to tackle diabetes through a $25 million donation from the F.O.E.
Proposer Information*

*All New and Re-Enroll Applicants must be proposed by two (2) Auxiliary Members of the Order in Good Standing. All Information must be completed below.
1st Proposer
Name
Middle Initial
Address
City
State
Zip
Membership ID #
2nd Proposer
Name
Address
City
State
Zip
Membership ID #
Dual Applicant Information:
Name
GAID #
Auxiliary #
Transfer Applicant Information:
Name
GAID #
Auxiliary #
Please fill out all applicable information above for our records.
I hereby certify that I profess to be of good moral character, and believe in the existence of Supreme Being, am not a member in any other Aerie or Auxiliary within the Order, am over eighteen (18) years of age,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 EO.E. shall be in conformity with the House Rules of that Aerie. I understand that my membership in the Order 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 past.

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

YesNo
If Yes, date:

MonthDayYear
Date
*I am a convicted felon:

YesNo
*(WI, HI, and Canada excluded from this question)
I am a registered sex offender:

YesNo
Signature

Clear
Date

MonthDayYear
Date
Printed Name
Should be Empty:

WHO WE ARE

AUXILIARY APPLICANT INFORMATION

AUXILIARY RE-ENROLLED MEMBER INFORMATION

Proposer Information*

1st Proposer

2nd Proposer

Dual Applicant Information: