BANNACK HISTORIC LODGE No. 3-7-77
Petition for Life Membership
To: The Worshipful Master, Wardens, and Brethren of Bannack Historic Lodge No. 3_7_77.
The undersigned certifies that he is a Master Mason in Good Standing and a member of
_______________________ Lodge No. ______, located at __________________, under the
jurisdiction of the [Grand Lodge of Montana] [Grand Lodge of ____________________, a Grand
Lodge that is recognized by the Grand Lodge of Montana] (Strike out one), and that he is
desirous of becoming a Life Member of your Lodge if found qualified. He further certifies
that he understands:
That the purposes of Bannack Historic Lodge No. 3_7_77 are to preserve the history of
Freemasonry in Montana and the original Masonic Lodge building in Bannack, Montana. No
degrees will be conferred by this Historic Lodge.
That membership in Bannack Historic Lodge No. 3_7_77 shall remain in effect so long as he
remains a Master Mason in good standing in a duly chartered Lodge under the jurisdiction
of the Grand Lodge of Montana or of a Grand Lodge recognized by the Grand Lodge of
Montana. Membership may be voluntarily severed at any time by resignation. Upon
resignation, no demit will be issued. (Sec 20070 A and D, Montana Code of Statutes)
That the privileges of holding office and voting in this Historic Lodge are restricted to
members who are Master Masons in good standing in a regular Lodge under the jurisdiction
of the Grand Lodge of Montana. (Sec 20070 B, Montana Code of Statutes)
Date of Petition: _____________________
Printed Full Name:__________________________________________________________________
Signature: ________________________________________________________________________
Address: __________________________________ City, State,
Zip:______________________________
Telephone: _______________________________ e-mail: ________________________
Instructions:
This petition must be accompanied by the petition fee, $37.77.
A Certificate of Membership, suitable for framing, is available for an additional $5.
Check here if you desire the certificate. G
A Bannack Lodge No. 3-7-77 lapel pin is available for an additional $5. Check here is you
desire the lapel pin. G
Shipping and handling for either the certificate or the pin, or for both is $2.23.
Summary of Fees: Petition fee only - $37.77; Petition fee and either pin or certificate
plus S&H - $45.00; Petition fee, pin, and certificate plus S&H - $50.00. Checks
should be payable to Bannack Historic Lodge No. 3_7_77, A.F.&.A.M.
A photocopy of the petitioner’s current dues card (front and back) must accompany the
petition.
Mail petitions, checks, and all correspondence to the Lodge Secretary: Thomas E. Valente,
Jr., 8624 Panorama Drive East, Bozeman, MT 59715. You can also contact the Lodge Secretary
by phone: (406) 586-7882 or e-mail: tomevale@aol.com.
FOR USE BY LODGE SECRETARY
NAME: ____________________________________________
Date petition received by secretary: ______________________________
Total funds received: ______________________________
Date membership card mailed: ______________________________
Date certificate mailed: ______________________________
Date lapel pin mailed: ______________________________
Date membership terminated by resignation: ______________________________
Date membership terminated by non-affiliation with a regular Lodge:
______________________________
Date of Death: ______________________________