AUXILIARIES' MEMBERSHIP APPLICATION

I am a member over 18

First name*

Last name*

Birthday

Email*

Phone*

Which Auxiliary are you applying for?*

Women'sAuxiliary

Men'sAuxiliary

Youth Auxiliary

Height

T-Shirt Size

Polo Shirt Size

Who referred you?

Referral's Name

Provide an abbreviated biography explaining why you want to become a member of Omicon Nu Xi Military Auxiliaries, Inc., your civilian education, accomplishments, and community service. (Not required for youth)

Answer the following questions with a minimum of one (1) paragraph:

1. Do you have a passion to help others in need? If so, why? (Not required for youth)

2. Do you currently perform Community Service? If so, what is it? (Not required for youth)

Medical Information (i.e. food allergies or medical Conditions):

Emergency Number 1

Emergency Contacts
(For youth only)

Address

Phone number

Relationship

Emergency Number 2

Address

Phone number

Relationship

I am: *

Parent

Legal Guardian

NOTE: Auxiliary member's Annual dues must be paid upon approval of your membership application. Payment information will be provided to you. *

YOUTH - $5

WOMEN - $100

MEN - $100

FOR OFFICAL USE ONLY (APPLICANT: SKIP THIS SECTION AND SUBMIT FORM):

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AUXILIARIES' MEMBERSHIP APPLICATION

Emergency Contacts (For youth only)

Emergency Contacts
(For youth only)