New Applicant  APPLICATION FOR AERIE MEMBERSHIP  Re-Enrollment
1. Name______________________________________________________
2. Date of Birth________________ Age_____
3. Residence Address_________________________________________________
City____________________ State/Prov.__________________________
ZIP______________ Telephone_____________________
Mailing Address (if different)____________________________________________
IF YOU HAVE EVER BEEN A MEMBER OF THIS ORDER BEFORE, THE FOLLOWING QUESTIONS MUST BE ANSWERED:
4. I formerly belonged to Aerie No.____ City___________ State/Prov._____
5. The reason for terminating my membership was_____________________________
6. Have you ever applied for membership and were rejected? If yes, where?_________

TO THE OFFICERS AND MEMBERS:
   I, being of sound body and mind, and believing in the existence of a Supreme Being, 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 Aerie within the past six
months, nor do I stand suspended by any Aerie of the Fraternal Order of Eagles.
   I further understand that until this application for membership is approved, accepted, and I am initiated, I shall
not be entitled to benefits of any kind in accordance with the laws of the Order.
   I understand that if I do not appear for initiation within six (6) months after my notice of election to membership,
my initiation fee will be forfeited, and my application for membership cancelled.
   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 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 Constitution and Statutes of the Fraternal Order of Eagles.

Applicant’s Signature______________________________________________ Date_______________

First Proposer: Aerie No.______
Name__________________________
Grand Aerie I.D. No.______________
Address________________________
City____________________________
State/Prov.___________ ZIP_______

Second Proposer: Aerie No._____
Name_________________________
Address________________________
City____________________________
State/Prov.___________ ZIP_______

TO BE FILLED IN BY SECRETARY

Application No._______________ In Aerie No.______ Fraternal Order of Eagles
Amount Paid_________ Official Receipt No.________
Date Reported to G.A. Membership Dept.: Month_____ Day_____ Year_____
APPLICATION APPROVED FOR
Beneficial or Non-Beneficial
Membership
Application Submitted___________________
Elected to Membership__________________
Date Initiated__________________________
Secretary_____________________________
We, your Committee, have interviewed the above-named applicant and recommend that he be
Accepted
Rejected
Re-Enrolled
for membership in this Order
FRATERNAL ORDER OF EAGLES Aerie Initiation Fee Receipt
Received from__________________________ Amount Received $___________
In payment of Initiation Fee in Aerie No.____ Received by____________________________
Signature of Sponsor__________________________________ Date _______

Detach and give this portion to Applicant