(Full
Name in full in BLOCK letters please) |
| hereby
apply to be elected as an associate or full member of the United Masters
Lodge No. 167, and I enclose $40.00 to cover one year's dues. |
| Tick box for
method of payment |
| Card expiry date:
__________ / ___________ / _______ |
| Dated
this _________________ day of ______________________ 20______
|
| Signature
________________________________________________________ |
Master
Mason |
|
Installed
Master |
|
| Please
tick appropriate box |
| Lodge
name, number, Constitution __________________________________________________________ |
Mailing address
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
email: __________________________________ |
| Please
print this form and send to the Secretary: Alan Bevins, 36 Murphys
Road, Manukau, 2016, New Zealand |
|