GENERAL APPLICATION PLEASE PRINT LEGIBLY
Auxiliary Name: ________________________________________________
City, State, Zip Code: ___________________________________________
Auxiliary Number: ___________________ ID Number: ______________
Chapter: _______________________________________________________
A-100 Rev. 8/18
AUXILIARY SECTION
First Name Middle Initial Last Name Area Code/Telephone #
[ ] NEW MEMBER
(Date of First Degree Must Be Included)
Street Apt. No. City [ ] TRANSFER
(Date of Degrees Must Be Included)
State or Province Country or Zip Code Email Address: [ ] REINSTATEMENT (Within One Year)
(Date of Degrees Must Be Included)
Are You a Practical Catholic Yes ______ No _______ DATE OF COLUMBIETTE DEGREES : [ ] READMISSION (After One Year)
(Dates of Degrees Must Be Included)
Previous Columbiette Affiliation Yes ______ No _______ First Degree (Date) ____________________________
[ ] WITHDRAWAL CARD
Major Degree (Date) ____________________________ (Dates of Degrees Must Be Included)
[ ] DEATH _____________________________
Date
Name of Last Auxiliary Location City State or Province [ ] CHANGE OF NAME
Date of Withdrawal/Suspension Reason: Former Name
____________________________________
Date of Transfer [ ] CHANGE OF ADDRESS
________________________________________________________________________________________________________________ Former Address
_____________________________________
Signature of Applicant __________________________________________________________________________________ _____________________________________
PERTAINING TO TRANSFERS ONLY
DATE OF TRANSFER
Proposer’s
President Financial Secretary
Signature _______________________________________________________________________________________________________
Of New Auxiliary
FINANCIAL SECRETARY SIGNATURES PRESIDENT
_____________
DATE
I hereby certify on my honor as a Columbiette/3
rd
Degree Knight of Columbus that I am acquainted with the above applicant, that I
know her to be a practical Catholic and that I endorse her as desirable and worthy of membership in the Columbiettes. I believe
her statements in this application to be true.
