Registration Form - Ancient Order of Hibernians

I am applying for :

Full : Applicant is either Irish by birth or decent AND Catholic

Associate : Applicant is not required to be Catholic or Irish by birth or decent.

First Name*

Middle Name

Last Name*

Suffix / Title

Date of Birth*

Occupation

Address Line 1*

Address Line 2

Zip Code*

State*

City*

Email address*

Phone no :

Cell Phone

Home Phone

Work Phone

I am Irish by :

Birth

Descent

Are you Roman Catholic?*

yes

a. What Parish do you belong to?

b. Have you complied with your religious duties over in the past 12 months?*

yes

c. Do you belong to any society to which the Catholic Church is opposed?*

Yes

Which Society?

Marital Status

Married

Single

Divorced

Other

a. Spouse’s Name:

a. Other Status:

b. Do you have any children?

Have you previously been a member of the AOH?*

Yes

State?

City?

County?

Division Name?

Division Number?

Reason for Leaving?

Name of Louisville, KY Division member who recruited you (if applicable)?

Answer any of the following that apply to you

I am clergy (Active or Retired Deacon or Priest of the Catholic Church)

I am active duty military

Army

Air force

Coast Guard

Marines

Navy

I am a veteran

Army

Air force

Coast Guard

Marines

Navy

I qualify for the discounted senior dues rate (65 or over this year)

I am a fulltime student

I am interested in participating in the following activities / committees :

Electronic Signature

Date

A $15 non-refundable application fee is required. Would you like to pay this by PayPal now or mail a check to the Membership Chair?

Pay Now

Mail Check

Note: The $15 application fee is waived for applicants who indicated that they are “Clergy” or “Active Duty Military”

First year annual dues are prorated based on the number of remaining months in the year. Would you like to pay them now by PayPal or pay after you've been accepted? Dues will be refunded if you are not accepted.

Pay Now

Pay Later

Total Amount due