TENNESSEE LODGE OF RESEARCH

PETITION FOR MEMBERSHIP

Date____________

To the Worshipful Master, Wardens and Brethren of the Tennessee Lodge of Research, F.&A.M. of Tennessee:

I,_____________________________________________
(FULL NAME, NOT JUST INITIALS),
at present a member in good standing of

______________________________ Lodge No._______, located at

______________________________ in the Grand Jurisdiction of

________________________________________________ Grand Lodge,
certify that my dues are paid to and that no charges are pending against me, make application for dual/plural membership in your Lodge and, if elected, I promise to conform to all the ancient usages and regulations of the Fraternity. In the event the laws of the responding jurisdiction do not legalize and/or permit dual membership, then this application shall become null and void.

Residence address (include zip):

Residence phone (include area code):

Business phone (include area code):

Date of Birth_____________

(SIGN ALL GIVEN NAMES IN FULL)

Presented (date):_________________
Elected:(DATE)________________
Rejected: (DATE) ______________

NOTES :



INSTRUCTIONS: Petition must be completed in full. Send completed petition, a photocopy of your current Blue Lodge dues card, and $15.00 ($5.00 for fees. $10.00 for dues) to:
Bro. George C. Ladd, Sec.
4521 Turkey Creek Road
Williamsport, TN 38487