Membership Petition | Acacia Lodge No. 91

Membership petition

Petition Acacia Lodge No. 91

Before you beginThis form contains personal questions required by the Grand Lodge petition. Please answer every question honestly and completely.

Required field

Personal information

Tell the lodge who you are and how to reach you.

Full legal name *Email address *Phone number *Home address *City *State *ZIP code *Years residing in this state *Place of birth *Date of birth *

Occupation and employment

Provide your current work information.

Occupation *Employer *Employer phone *Employer address *

Recommendations and beneficiary

If you know any Master Masons in good standing who can recommend you, list them below. This section is optional and may be completed by the lodge.

Recommender 1 OptionalRecommender 2 OptionalRecommender 3 OptionalBeneficiary full name *Beneficiary address *

Electronic signature

Review your answers before signing and submitting.

Type your full legal name *Date signed *

I understand that typing my name constitutes my electronic signature, and I certify that the information in this petition is true and complete to the best of my knowledge.

By submitting, you are petitioning Acacia Lodge No. 91 under the Most Worshipful Prince Hall Grand Lodge of Kansas.

Take the next step with intention.