top of page

HOME
ABOUT US
LEADERSHIP
CHAPTERS
APPLICATION
SHOP
DUES
CONTACT US
MEET & GREET

Phone number

First name

Last Name

Address

Which Auxiliary are you applying for? *

Women's Auxiliary

Men's Auxiliary

Youth Auxiliary

D.O.B.

AUXILIARIES' MEMBERSHIP APPLICATION

I am a member over 18

First name*

Last name*

Birthday

Month

Day

Year

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):

Signature

Your content has been submitted

Site deisgned by Hitch Network Connections, LLC

HOME
ABOUT US
LEADERSHIP
CHAPTERS
APPLICATION
SHOP
DUES
CONTACT US
MEET & GREET

bottom of page

AUXILIARIES' MEMBERSHIP APPLICATION

Emergency Contacts (For youth only)

Emergency Contacts
(For youth only)