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Samaritan Lodge Membership Application
To apply for membership to The Odd Fellows Lodge
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Email *
Name
Birthdate
MM
/
DD
/
YYYY
Place of Birth
Occupation
Employer
Address
Mailing Address
Telephone
Email
Preferred Contact Method
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Parent/ Guardian if under 18
Lodge Sponsor
Applying for membership by
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Why do you want to become a member of Samaritan Lodge?
Preferred days/ times for your interview
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