AuxComm USA Membership Application

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Adresse e-mail *

AuxComm USA. A Presidential Award Winning Organization

First Name *

Last Name *

Complete Mailing Adress (No PO Boxes) *

Phone Number *

Drivers License or State ID Number or InfraGard Member Number *

Date of Birth *

Do you consent to a background check?
NOTE: We are not able to proceed with background checks until annual dues are paid. If we find a disqualifying history, your dues will be refunded in full. *

Yes

What position are you applying for? *

Regional Coordinator

State Coordinator

Area Coordinator

Volunteer Communicator

Do you agree to live our 5 Pillars of Character?
1. Honesty - Be truthful in all things
2. Integrity - Do what you say you are going to do, even if it is inconvenient
3. Loyalty - Be faithful to this organization and represent it well
4. Tenacity - Never give up, even in the face of overwhelming odds
5. Safety - Protect yourself, your family, your community, and your country *

Yes

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