Petition for Plural Membership Plural Memberhship To the Worshipful Master, Wardens, and Brethren of Millersville Lodge No. 126 F. & A. M. Indianapolis, IN THE PETITION of the subscriber respectfully represents that he is a Master Mason in good standing in First Lodge of Membership Name, Lodge No. & StateFirst Lodge of Membership Name, Lodge No. & StateThird Lodge of Membership Name, Lodge No. & Stateand hereby petitions for plural membership in Millersville #126If found worthy, he pledges himself to a cheerful compliance with the by-laws of Millersville Lodge No. 126 and to the usages and customs of the Fraternity.Birth Date MM slash DD slash YYYY Birth DateThe subscriber acknowledges that, if elected, he shall be entitled to all the rights, and subject to all the obligations, of each Lodge in which he holds membership, except that he shall not hold the office of Worshipful Master or Warden in more than one Lodge at the same time. He acknowledges further that involuntary loss of membership in one Lodge shall have a like effect in the others.Place of Birth Place of Birth (City/State/Zip)Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Occupation SignatureRecommended by Brothers Referred by whom First Last Referred to the following committee:Referred by whom First Last Referred to the following committee:Referred by whom First Last Referred to the following committee:DispositionPresentedElectedRejectedDispositionPetitioner’s Questionnaire (Petition and questionnaire to be filled out in detail and signed by petitioner in his own handwriting)Name First Last Age PhoneResidence Phone #PhoneBusiness Phone #Father's Name First Last Is (or was) your father a Mason? Yes No Father's Lodge If so, in what Lodge is (or was) his membership?Brother's Masons? Are any of your brothers Masons?Names & LodgesLodge Name/AddressLodge Name/AddressLodge Name/AddressIf so, give their names, addresses and names and locations of their Lodges
