Form No.19 - Plural Membership Petition
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The G rand L odge o f F ree a nd A ccepted M asons o f t he S tate o f M ichigan
PLURAL M EMBERSHIP P ETITION
To t he W orshipful M aster, W ardens, a nd B rethren o f _ __________________________________
Lodge N o. _ _______ F ree a nd A ccepted M asons o f M ichigan:
The s ubscriber, a M aster M ason, a nd n ow a m ember o f _ _________________________________
Lodge N o. _ _______ u nder t he j urisdiction o f t he G rand L odge o f _ ________________________
respectfully p etitions f or P lural M embership i n y our L odge; i f f ound w orthy, h e p ledges
himself t o a c heerful c ompliance w ith t he B y-‐Laws o f y our L odge a nd u sages a nd c ustoms o f
the F raternity a nd h as b een a M ichigan r esident f or t he l ast 6 m onths.
The S ubscriber a cknowledges t hat, i f e lected h e s hall b e e ntitled t o a ll o f t he r ights a nd b e
subject t o a ll o f t he o bligations o f e ach L odge t o w hich h e b elongs, e xcept t hat h e s hall n ot
hold o ffice, o ther t han t hat o f T iler, M usician o r T rustee i n m ore t han o ne L odge a t t he s ame
time. F urther, t hat s uspension o r e xpulsion f rom a ny L odge s hall h ave l ike e ffect i n a ll
other l odges,
Name:
MORI I D _ _________________
Residence i s: _ ____________________________________________________________________
(must h ave b een d omiciled i n M ichigan f or t he l ast 6 m onths)
Date o f B irth: _ _________________________ P hone: _ ____________________________
Month/Day/ Y ear
Place o f B irth: _ __________________________________________________________________
(City/Town)
(State)
He r eceived t he d egrees i n:
Lodge N o.
This j urisdiction m ust p ermit D ual/Plural M embership
In t he S tate o f _ _________________________________________
, a s f ollows:
Initiated _ _________________ P assed _ _____________________ R aised _ __________________
His d ues a re p aid t o: _ ____________________________
He h as r esided w ithin t he S tate o f M ichigan f or 1 2 m onths p receding t he d ate o f
his a pplication: _ _________________________
Signed:
(Sign f ull n ame)
Recommended B y:
Date:
FORM N O.19 -‐ A VAILABLE F ROM T HE G RAND L ODGE O FFICE O R W
(Revised 2 013)
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