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AAS024 MEMBERSHIP APPLICATION
TO THE APPLICANT: Your application for approval by the African American Society #024 (AAS) Board or a designated committee may involve a personal interview conducted with you and your sponsor
.
*ALL QUESTIONS ARE REQUIRED TO BE ANSWERED. Questions/Instances that may not apply to applicant please populate with Non-Applicable (N/A)
***Founding Members Rate: $180/year (FOUNDING MEMBERS ONLY!!! - 2024 & 2025)
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle Initial
Your answer
Last Name
*
Your answer
Street Address
*
Your answer
City
*
Your answer
Zipcode
*
Your answer
State
*
CT
Other:
Phone Number (Home & Cell)
*
Your answer
Preferred T-Shirt Size
Small
Medium
Large
XLarge
XXLarge
XXXLarge
Other:
Veteran Status
*
Non-Veteran
Veteran
Service-Disabled Veteran
Spouse of Veteran
Not Disclosed
Other:
Gender - Self Identify (Male, Female, Etc.)
*
Your answer
Email
*
Your answer
Age
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Nationality -
PLEASE LIST
- Self Identify (American, Nigerian, Etc.)
*
Your answer
Ethnicity -
PLEASE LIST
- Self Identify (African American, Bantu People, Etc.)
*
Your answer
Race -
PLEASE LIST
- Self Identify (Black, Hispanic/Latino, Native American, Etc.
*
Your answer
Martial Status
*
Single
Married
Divorced
Widowed
Remarried
Other:
Known Languages -
PLEASE LIST
(English, Swahili, Arabic, etc.)
*
Your answer
Work Industry/Occupation: (Doctor, Plumber, Insurance, Service, Lawyer, Carpenter, Retired)
*
Your answer
Place of Employment:
*
Your answer
How did you hear about the organization?
*
Your answer
Have you been a member of another club before?
*
Yes
No
Required
Which club(s) have you previously been involved with? -
PLEASE LIST
(Elks, VFW, Etc.)
*
Your answer
Emergency Contact Information (Name, Relation, Phone#)
*
Your answer
***Potential Member Signature***
(Signature, Printed Name, Date)
*
The undersigned does hereby apply for membership pledging that they will observe all rules and regulations already in place as well as those enacted in the future.
Please submit with application the membership fee of $180.
(
The membership fee is a yearly fee
).
I accept membership into The African American Society #024 (AAS) and that the standards are limited to persons of good moral character and reputation. I recognize the importance of rendering personal service to my community in cooperation with other productive-minded people. I understand that membership is not valid until approved by the board of directors and/or general member voting.
Your answer
Sponsor Information Below:
(Name, Phone Number, Email Address)
*
*If you have not been referred by a current member, you may receive a phone and/or email from the Secretary to schedule a short interview.
Your answer
TO THE APPLICANT: Your application for approval by the African American Society #024 (AAS) Board or a designated committee may involve a personal interview conducted with you and your sponsor.
If your application is denied, our Treasurer will promptly return all monies submitted.
*Only regular voting members, in good standing, can sponsor an applicant. If you are not sponsored the Secretary will reach out for a brief interview.
Your answer
Payment
*
Cash App: $AAS024
Personal Check (Made to: African American Society #024)
Cash (Hand delivered to 12 Manila Ave Hamden CT 06514)
Cash App
A copy of your responses will be emailed to the address you provided.
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