INTERNATIONAL MASONIC ORDER “DELPHI”

 APPLICATION FOR ADMISSION

Date: ____________

Print out, complete and send to: 

Victoria Karpos, Secretary

Athena Lodge

947 West Folsom Ave.

Salt Lake City, Utah  84104

 

Ladies and Gentlemen:

I hereby have the honor to request your approval for my admission to the Venerable Lodge ATHENA.

 Personal Data:

Family Name  _______________________________________________

Name(s)          _______________________________________________

Profession       _______________________________________________

Birth Data:

 

Date: ____________________  

 Place:__________________________________________________________________

 

Personal I.D. Card  ( i.e. Driver's License Number or Passport Number)

 

Number ________________ Authorities _________________________________________

 

Parents’ Data

 

Father’s Name _________________________ Mother’s Name _______________________

 

Family

 

Married/Single/Widower/Divorced: ____________________________________________

 

Children (number, age, sex): ___________________________________________________

 

Permanent Residence

 

Address: ____________________________________________________________________

Zip Code __________ City, County, State: _________________________________

Phone(s) ____________________________________________________________________

 

Professional Data

 

Name of Company ____________________________________________________________

Position in the Company ______________________________________________________

Address ____________________________________________________________________

Zip Code ____________ City, County, State _____________________________________

Phone(s) ____________________________________________________________________

 

Academic and individual education

 

Schools, Colleges, Faculties, Universities and Certificates thereby ____________________

____________________________________________________________________________

Foreign Languages ___________________________________________________________

Other interests _______________________________________________________________

____________________________________________________________________________

 

Personal Beliefs

Do you believe in the freedom of thought, of speech and of conscience?______________

Do you believe you have done your duty to your fellow man? _______________________

What is your purpose or desire to be admitted in Free Masonry? ____________________

__________________________________________________________________________

 

Other information

 

Have you ever made an application to another Lodge? When was that? _______________

How can one meet you? ______________________________________________________

Do you know Free-Masons? Who are they? ______________________________________

(Family name/name(s)/phone(’s) _______________________________________________________________

Mention friends of yours, not Free-Masons, who can give information about you.

(Family name/name(s)/phone(’s) _______________________________________________________________

___________________________________________________________________________________________

 

I hereby certify all the above mentioned information to be true and correct.

Honorably

 

Signature

This Application is supported by:  (Family name/name(s)/signature)

 

1. ________________________________________________________________as sponsor

2. ________________________________________________________________

 

 

         

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