APPLICATION FOR MEMBERSHIP – Print out this page and fill in the requested information and submit to the address listed below

MEMBERSHIP TYPE:                Regular_____                      Associate_____

NAME:____________________________, __________________________, _________________________

                           (last)                                       (first)                                 (middle)

SPOUSE’S FIRST NAME: ____________________                 MEMBER? Yes ____  No ____

RESIDENCE ADDRESS: _______________________________________________________

                                            ____________________________,_________      ______________

                                                                  (city)                             (state)                    (zip)

DATE OF BIRTH: ____/____/________                              SSN: ______-____-_______

PHONE:Home: (_____-____-_________ Business: (_____-_____-_________ E- Mail__________________________________

BUSINESS TITLE:__________________________________________________________

Periods of service, posts of duty and GS-1811 positions held for Regular Membership, or qualifying positions in which served for Associate Membership:  BE EXPLICIT OR APPLICATION WILL BE RETURNED. (Use Back For More Space)

______________________________________________________________________________________________

Applicant authorizes the Fraternal Order of Border Agents, Inc. to conduct such inquiries as it deems necessary to determine Membership eligibility.

______________________________________________              _________________

Signature                                                                                 Date

Referred by:__________________________________________________________________

Please send completed application with check for $40.00 (includes $20.00 initiation fee and $20.00 annual dues Enclose

an additional $20.00 if you wish your spouse to become an Associate Member.

Mail completed application and your check payable to FOBA to:
FOBA, PO Box 3526. Waco, TX  76707                                             

E-Mail. aaareblinc@aol.com

FOR OFFICIAL USE ONLY:

Approved:______     Disapproved: ________                    Date: ____________

Record entered: ____/____/_______                    Membership package sent:  ____/____/_______

___________________________________________

Signature of Membership Chairman