Application For Affiliation Form printable pdf download

TYPE

Application For Affiliation

_____ Singular

(See instructions on back)

_____ Plural

Read ________________________________ , 20 ____

Elected ______________________________ , 20 ____

Rejected _____________________________ , 20 ____

To the Master, Wardens, and Members of ______________________________ Lodge No. ________

(Print or type) Name in full _______________________________________________________________________________

(First Name)

(Middle Name)

(Last Name)

(Applicant sign Name in full) ______________________________________________________________________________

(First Name)

(Middle Name)

(Last Name)

The subscriber, a Master Mason, and a member of __________________________________________Lodge No. ________,

located at ___________________________________, under the jurisdiction of the Grand Lodge of ______________________________,

respectfully applies for membership in your lodge. If found worthy, he pledges himself to cheerful obedience to your

laws and the ancient usages of Masonry.

Accompanying this application:

r SiNgular - include:

r Current Year’s Dues Card and Request for a Demit

- or -

r Demit

- or -

(Photocopy Front and Back)

(located at Bottom of Page 2 on This Form)

r Current Year’s Dues Card

r Plural - include:

(Photocopy Front and Back)

He freely and voluntarily answers as follows:

Date of birth _____________________________ Place of birth ____________________________________________________

(City, State)

His occupation is ______________________________________________________________

(Note 6)

He is employed by _________________________________________________________________________________________

Business address __________________________________________________________________________________________

(Number)

(Street, Apt.)

(City, Town)

(State, Zip)

Father’s Name ____________________________________________________________________________________________

(First Name)

(Middle Name)

(Last Name)

Mother’s MAIDEN Name: __________________________________________________________________________________

(Note 7)

(First Name)

(Middle Name)

(Last Name)

Wife MAIDEN Name: ______________________________________________________________________________________

(Note 7)

(First Name)

(Middle Name)

(Last Name)

Residence address _________________________________________________________________________________________

(Number)

(Street, Apt.)

(City, Town)

(State, Zip)

Address for Mail ___________________________________________________________________________________________

(Number)

(Street, Apt.)

(City, Town)

(State, Zip)

HomePhone: _________________________________________ Business Phone: _____________________________________

Mobile Phone: ________________________________________ Email: ______________________________________________

Degrees were conferred in ___________________________________ Lodge No. _________, at ________________________

as follows: EA _____________________________; FC _____________________________; MM __________________________

(Date & Year)

He presently is or has been a member of the following lodges, beginning with the one in which he received the degrees:

Years of Membership

lodge Name

No.

Where located

From (Date & Year)

To (Date & Year)

_______________________ ______________________

________________________ ____________ _________________

_______________________ ______________________

________________________ ____________ _________________

_______________________ ______________________

________________________ ____________ _____ __________

Application For Affiliation Form

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