Membership Petition

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Personal Details

(*) All applicable sections are expected to be completed. An incomplete petition may halt the process of your membership. Your petition does not guarantee your membership, all petition go through our investigation process.

Date of Petition

Petitioner Name

First

Last

Petitioner Phone Number

Upload Your Resume

Drag & Drop Files, Choose Files to Upload

Take a picture of yourself.

To validate you are who you say you are please take a photo of yourself.

Take a picture of your Drivers License.

To validate you are we would like for you to upload a copy of your drivers license.

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email Address

Who is recommending you?

Do you believe in a Supreme Being?

Is this petition of your own free will and accord?

Have you ever petitioned for Masonic membership and been rejected by any Masonic Lodge?

Masonic Lodge of Rejection

Date / Time

Date

Time

Lodge Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

*Please provide two points of contact (e.g., Worshipful Master / Secretary):

Full name

Lodge P.O.C. Phone 1

*Please provide two points of contact

Full name

Lodge P.O.C. Phone 2

*If you are an inactive Mason from another jurisdiction, do you have:

Dues Card
Certificate(s)
Other (specify):

EMPLOYMENT INFORMATION

Employer Name

Position

How long have you been employed?

Address

Address Line 1

Address Line 2

City

State

Zip Code