Membership Application - Northern Masonic Club

Northern Masonic Club

Membership Application Form

Fields marked with * are required.

Membership Type*

Foundation Member ($150 then $100 per year) Member ($100 per year)

Full Name*

First Name

Last Name

Email Address*

Contact Number*

Occupation*

Lodge Number*

Lodge Name*

Home Address*

Street Address

City

Zip / Postal Code

Emergency Contact Name*

First Name

Last Name

Emergency Contact Number*

Relationship to Applicant (e.g. spouse, parent, friend)*

By submitting this application, whether electronically or by any other means, I hereby apply for membership of the Northern Masonic Club. I acknowledge and agree that, if accepted as a member, I will be bound by the Constitution, Rules, Regulations, Policies, Code of Conduct, and any lawful amendments of the Club. I further understand that continued membership is conditional upon maintaining good standing within Freemasonry, complying with all Club requirements, rules, and standards, and conducting myself in a manner consistent with the values, traditions, and reputation of the Northern Masonic Club. I also acknowledge that the Club reserves the right to accept or reject any application at its discretion.