Craft Registration Form M

Personal Information

Surname *

Forename *

Middle Names

Date of Birth *

Contact Information

Home Address (Line 1) *

Address (Line 2)

City *

County

Post Code *

E-Mail Address *

Phone Number

Mobile Phone Number *

Employment Information

Employer Name

Job Title / Position

Business Address

Lodge Membership History

Please provide details of all lodges you have been a member of.

Lodge 1

Name and Number of Lodge *

Constitution (if not UGLE)

Date of Admission *

Date of Leaving

Masonic Rank

Clearance Declaration *

I do not owe any money to any of these Lodges I owe money to one or more of these Lodges and have provided details

Declarations

Please answer the following questions honestly. These are required for compliance purposes.

Are you currently unattached, or are you joining from an overseas constitution? *

Yes No

Have you ever been convicted of a criminal offence? *

Yes No

Have you ever been disciplined as the outcome of any professional, military, trade or other tribunal? *

Yes No

Are you awaiting the outcome of proceedings against you before a criminal court, or a professional, military, trade or other tribunal? *

Yes No

To the best of your knowledge, are you the subject of any criminal, professional, military, or trade investigation? *

Yes No

Proposer and Seconder

Proposer *

Use my own Use Lodge Defaults

Seconder *

Use my own Use Lodge Default

Signature

Please sign below using your finger, stylus, or mouse.

I confirm that all information provided is accurate to the best of my knowledge

Personal Information

Contact Information

Employment Information

Lodge Membership History

Lodge 1

Declarations

Proposer and Seconder

Signature

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