Joining Form

  I  
     
(Name in full in BLOCK letters please)

hereby apply to be elected as a member of the United Masters Lodge No. 167, and I enclose $40.00 to cover one year's dues.

cheque

               

Visa

              

Mastercard

                    
Cheque or card number  
      
      
       
       
       
       
       
       
       
       
       
       
      
      
    
      
Card expiry date: __________ / ___________ /   _______
Dated this  _________________ day of  ______________________ 2002
Signature  

________________________________________________________

 
Master Mason
 
Installed Master 
Lodge name, number, Constitution  

__________________________________________________________

Mailing address

________________________________________________________________________________________
                             ________________________________________________________________________________________
                             ________________________________________________________________________________________
                            ________________________________________________________________________________________

Please print this form and send to the Secretary:   Alan Bevins, 36 Murphys Road, Manukau, 2016, New Zealand
Back to Joining details Back to Secretary's Page Fwd to Library/Museum