Application for Membership
Mail to:
Patrick V. Dyer
54 Scott Adam Road,  Suite 207
Hunt Valley, MD 21030
To the Board of Managers,
Hibernian Society of Baltimore                                                Date                                                                      

Gentlemen:

I endorse for membership in the Hibernian Society of Baltimore, the applicant whose signature appears on the face
of this form and furnish below, proof of his Irish Ancestry, as required by the By Laws of the Society.
He is personally known to me and I regard him as a gentleman who will be a credit to our Society and one who is
interested in the ideals for which our Society was founded.

        Regular Member                                  Junior Member (under age 18)

Name of Applicant

Home Address                                                                                                                Zip Code                                 

Home Phone                                                                                                                                                                 

Business
Association                                                                                                                                                                             
                          

Business Address                                                                                                          Business Phone                          

Signature of Applicant                                                                                                                                                 

Proposed by                                                                                                                                                                 
DIRECT IRISH ANCESTRY
(Please give names, relationship and place of birth of Irish parents, grandparents, great-grandparents, etc.)