APPLICATION FOR MEMBERSHIP PETITION FOR INITIATION. To the Worshipful Master, Wardens and Brethren of Lodge No. F &A.M.

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1 Prince Hall Grand Lodge F. &A.M. APPLICATION FOR MEMBERSHIP PETITION FOR INITIATION To the Worshipful Master, Wardens and Brethren of Lodge No. F &A.M. I, residing in and being the lawful age of, do declare that unbiased by the improper solicitation of friends, and uninfluenced by mercenary of other unworthy motives, I freely and voluntarily offer myself a candidate for the mysteries of Free Masonry. That I am prompted by a favorable opinion conceived of the institution and a desire of knowledge; and that I will cheerfully conform to all the ancient usage's and established customs of the order. I have never before petitioned a Masonic lodge for initiation (or I have heretofore petitioned Lodge No. but was rejected on or about the day of,year.) Witness under my hand this day of 20. Signed: Recommend by: Any false, incorrect or fraudulent statement upon this application shall, upon due proof of the same, at any time render it null and void.

2 APPLICATION FOR MEMBERSHIP Privacy Act Statement Some of the information in this form is privileged and cannot be disclosed without your consent. You are not required to complete this form, but failure to do so may result in denial of membership. I, hereby make answer to the following questions in my own handwriting and agree that the acceptance of my application shall not entitle me, my family, heirs, assigns or those who may be dependent upon me any benefits from Lodge No., or the Most Worshipful Prince Hall Grand Lodge of New Mexico until I have received the third (3 rd ) degree Masonry. And the same has answers and statements hereinafter mentioned and all those I make to the medical examiner of this in continuation of this application are full, correct and true so far as I am aware. Signed: Name in Full:(print or type) Address: City: State Zip Home Phone: Work Phone: Occupation: Place of Birth: How long have you lived in this city? Name and address of nearest relative: Permanent home of record Married or single: Date of marriage Wife's full name and address Total number of children dependent upon you: Have you ever been divorced? Do you believe in a Supreme Being? Have you been convicted & sentenced for violation of any state/federal laws? Have you ever applied for membership in any Masonic Lodge in or out of this state?. If so, state when and where. What other Masonic or fraternal orders are you now a member? In case of your death, to whom do you want your Masonic relief paid? Beneficiary Full Name: Address: City: State Zip Home Phone Number: Do you promise upon your word as a man, to yield a willing and faithful obedience to all the laws and regulations of our order and those of our lodge?.

3 APPLICATION FOR MEMBERSHIP MEDICAL CERTIFICATION 1. Are you in good health? If not explain: 2. Do you have high blood pressure? 3. Are you presently taking medication?. If yes, for what purpose

4 APPLICATION FOR MEMBERSHIP REPORT OF INVESTIGATION COMMITTEE On the application for membership in Lodge No., we the undersigned Investigation Committee, certify that the foregoing is a full and correct statement of Mr. as far as we can learn. Investigation Committee Signatures: Dated:, 20 Application of Mr. In Lodge No.. City of, State. Date Initiated 20. Date Passed 20. Date Raised 20. Date Reinstated 20. Date Affiliated 20. Date Healed 20. Worshipful Master Secretary No applicant's name will be enrolled in the Most Worshipful Prince Hall Grand Lodge of New Mexico's Burial Fund Department unless this application is recorded with the R.W. Grand Secretary and the payments of all fees required are paid.

5 PETITION FOR AFFILIATION To the Worshipful Master, Wardens and Brethren of Lodge No. F.& A.M.. The undersigned, a Master Mason, now a member of Lodge No. under the jurisdiction of the Most Worshipful Prince Hall Grand Lodge of: Respectfully applies for affiliation in your lodge. My age is:. My occupation is:. Address: City: State: Zip:. Telephone number: Printed/Typed name: Signed : Recommended by:

6 PETITION FOR REINSTATEMENT To the Worshipful Master, Wardens and Brethren of Lodge No. F.&A.M.. The subscriber, a suspended Master Mason of Lodge No. under the jurisdiction of the Most Worshipful Prince Hall Grand Lodge of New Mexico fraternally petition for reinstatement. If accepted I pledge myself to a cheerful obedience of your by-laws and the ancient usage's of Masonry. My age is: My occupation is: My address is: City: State: Zip:. Telephone number:_ Printed/Typed name: Signed: Recommended by:_

7 Of the State of New Mexico Inc. 525 San Pedro NE PETITION FOR HEALING To the Worshipful Master, Wardens and Brethren of Lodge No. F.& A.M.. The subscriber, a member of a clandestine lodge, Lodge No. City, State. Do hereby swear that I had no knowledge of the fact that Lodge No. was working in a clandestine manner. I hereby severe all ties with the clandestine lodge. My age is:. My occupation is: My address is: City: State: Zip: Telephone Number: Printed/Typed name:_ Signed: Witness:

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