Mullan Pass Historic Lodge No. 1862
To: The Worshipful Master, Wardens, and Brethren of Mullan Pass Historic Lodge No. 1862:
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 (Strike out one:) [ Grand Lodge of Montana] [ Grand Lodge of ________________________, a Grand Lodge that is recognized by The Grand Lodge of Montana] and that he is desirous of becoming a Life Member of your Lodge if found qualified. He further certifies that he understands:
ThatLife Membership is restricted to Master Masons in good standing.
Printed Full Name:___________________________________
Address: _______________________________ City_________________, State_______,
Zip :___________Telephone: ________________ e-mail: ____________________________
Signature:________________________________ Date of Petition: __________________
Instructions:
The petition fee, $55.00, must accompany this petition, this will include a Life Membership Card, A Certificate of Membership and a Mullan Pass Historic Lodge No. 1862 Member lapel pin .
Checks should be payable to Mullan Pass Historic Lodge No. 1862, A.F.&.A.M.
If the petition is submitted by mail, a photocopy of the petitioner’s current dues card (front and back) must accompany the petition.
Mail petitions, checks, and all correspondence c/o Lodge Secretary: Helena Lodge No. 3, P O Box 896, Helena MT 59624. You can also contact the Lodge by e-mail: mullan1862@helenamasons.org.
Mullan Pass Historic Lodge No. 1862
Life Membership Information
DUES CARD CERTIFICATION . ( A copy of a current dues card must be provided and examined by a member of the Board of Trustees, or a photocopy must be enclosed with this application )
I have determined that the petitioner has a current dues card/credential from a duly chartered
Lodge under the jurisdiction of the Grand Lodge of ___________________________.
Signature___________________________________ Date: __________________
( To be signed by a member of the Board of Trustees if a photocopy of the dues card is not enclosed with this application )
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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: ______________________________