Membership Application

Your Name *

Your Address *

Date of Birth (dd/mm/yy) *

Landline/Mobile *

Email

Your Occupation *

Current Employer (Name and Address)

Have you ever been proposed for membership in any Lodge, or has your admission to any Lodge ever been sought either by yourself or by anyone on your behalf? *

YesNo

Do you believe in God or a Supreme Being? *

YesNo

Are you prepared to take an obligation on the Bible or the Book of your faith? *

YesNo

Do you have a criminal record, or any impending court cases? *

YesNo

Details of criminal convictions If you answered 'yes' to the above question, please provide details of any criminal convictions or impending court cases.

Do you know any other Freemasons? *

YesNo

Does your partner support your move to join a Masonic Lodge? *

YesNoNo Partner

Please state below briefly why you wish to become a Freemason. It would be useful to know if you have family or other connections with Freemasonry, what you hope to gain and what you feel you can perhaps contribute should you become a member.

By returning this form, I agree for you to use the information I have provided above with a view to my becoming a Freemason. *

Agree

Scarsdale Lodge 681

Your Name

Your Name

Your Address

Your Date of Birth

Telephone Contact Details

Email Address

Occupation

General Information

Personal Statement

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