Ancient Order of Hibernians in America, Inc.
|……………………………Please type or print clearly………………………………|
|My name is _________________________________Occupation___________________________________
Age_________ Born on___________ Are you Irish by birth or descent? Yes _____ No _______________
What was your mother’s maiden name? _______________________________________________________
Are you a Roman Catholic? ________ Have you complied with your religious duties? __________________
Name of you Parish or Church ______________________________________________________________
Do you belong to any society to which the Catholic Church is opposed? _____________________________
Your Residence: ____________________________________________________________________________
City: ___________________________ State: _____________________ Zip Code ___________________
Business address: __________________________________________________________________________
Phone # (H) __________________________________ Business # (B) _______________________________
Were you ever previously a member of the A.O.H., if so, in what City or Town and State? _______________
What was your previous membership number, if available? _________________________________________
What was the reason and date of your withdrawal? _________________________________________________
I herby certify on my honor as a member of the Ancient Order of Hibernians, Inc., that I am acquainted with the above applicant. I know him to be a practical Catholic, and one worthy in every way to become a member of this order.
Your committee to whom was referred the application of:
would respectfully report that we have investigated the qualifications of said applicant for membership in the Order and recomment him for said membership.
I hereby certify that this application has been read to me at a regular meeting and that the applicant has been elected by the membership of this division on the
________ day of __________20 ________
I hereby certify that the initiation fee of $__________ has been paid on the _______ day of __________ 20 _____
AOH National office: 31 Logan St., Auburn, NY 13021
Phone (315) 252-3895 - FAX (315) 252-6966