ADMISSION OR AFFILIATION REQUEST

MOST WORSHIPFUL GRAND REGULAR HISPANIC LODGE OF USA

Worshipful Symbolic Lodge

Valley

Orient

APPLICANT INFORMATION

Full Name and Surname

Nickname

Date of Birth

Age

E-mail

Address

City

State

ZIP Code

Mobile Phone

Religion

Marital Status

BUSINESS, JOB, EMPLOYMENT INFORMATION

Business Name, Employer Name and/or Occupation

Current Employer

Address

Time

City

State

ZIP Code

Phone Number

Website

E-mail

Currently Active

PERSONAL INFORMATION

Place of Birth (City, State, Country)

Identity Document

Marital Status

Completed Studies and Degrees

Which Cultural or Charitable Associations are you affiliated with?

Has any acquaintance of yours belonged or currently belongs to Freemasonry?

Do you believe in a Supreme Being, called God, Coordinating Intelligence, etc.?

Do you believe in immortality, whether of the soul, energy, reincarnation, etc.?

Do you consider yourself a free man of good morals?

Spouse name

Date of Birth

Phone

REFERENCES

Reference 1 (Name, Address, Phone)

Reference 2 (Name, Address, Phone)

Reference 3 (Name, Address, Phone)

DECLARATION AND CLARIFICATION

I, the undersigned, without having been influenced by anyone or by improper or mercenary motives, affirm on my word of honor that 1) all information in this request is truthful, 2) I have read the Masonic program (page 1) and I understand the purposes of this respected Institution of Ancient, Free and Accepted Masons, and 3) of my own free and spontaneous will I offer myself as a candidate to Freemasonry and respectfully request admission, promising to abide by all established usages and submit to all requirements of the institution; declaring that during the last year I have not been rejected by any lodge and that I reside within the jurisdiction.

Applicant Name

Date

MASTER MASONS RECOMMENDING THE APPLICANT

#1 Firma

#2 Firma

#3 Firma