Application for Membership in Peninsula Lodge #128
Last Name *
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First Name *
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Place of Birth *
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Date of Birth *
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Occupation *
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Home Address *
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City *
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State *
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Zip Code *
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Mailing Address if different
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City
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State
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Zip Code
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E-mail Address *
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Phone Number *
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I am requesting membership by: *
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I agree that, if elected to membership, I will conform to the Constitution and By-laws of Peninsula Lodge #128 and the Grand Lodge of Oregon. I understand that my rights as a member will be protected by the Order, and will seek my remedy for all rights on account of my membership within the tribunals of the Order, without resorting to the civil courts. *
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I believe in a Supreme Being/Higher Power and I am loyal to my country. *
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I understand that membership in Peninsula Lodge is about me giving my time to improve the community. I understand that it is expected that members will attend at least one meeting a month (Meetings held second and fourth Tuesday of each month at 7:30 pm) and will willingly help out at lodge events and community service projects. *
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Do you know a current member of the lodge who can be a reference/sponsor for you? *
If yes, who?
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