Apply For Membership Application for Membership I hereby apply for admission into the Ancient Order of Hibernians in America, Inc., and agree that my reception and continuance in said Order shall depend on the truthfulness of my answers to the questions which are hereto attached, which answers are made by me for the purpose of gaining admitted to the order.TO BE A MEMBER YOU MUST BE A PRACTICING CATHOLIC AND BE OF IRISH HERITAGE BY BIRTH OR DESCENT. (Only Exception: Clergy need not be Irish.) My Name is:* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone*Cell PhoneWork PhoneEmail* Occupation*Date of Birth* MM DD YYYY Irish by:*BirthDescentAdoptionMother's Maiden Name*Are You Catholic?*Roman Catholic Other Catholic Rite Recognized By the PopeName of Your Parish*Have you complied with your religious duties within the past 12 months:*YesNoDo you belong to any Society to which the Catholic Church is opposed?*YesNoWere you ever previously a member of the Ancient Order of Hibernians before?*YesNoIf you were a member before please give the City, State, Division # and reason for withdrawalDivision of Choice*Any DivisionDiv. 3 - Five TownsDiv. 7 - LevittownDiv. 8 - Glen CoveDiv. 11 - HicksvilleDiv. 14 - LynbrookDiv. 15 - MassapequaDiv. 17 - Long BeachDiv. 19 - Port WashingtonI do solemnly pledge my sacred word and honor that the answers I have given to the above questions are true.* I Do Pledge VerificationCommentsThis field is for validation purposes and should be left unchanged.
