The Great Priory of the United Religious, Military and
Masonic Orders of the Temple and of St. John of Jerusalem, Palestine, Rhodes and Malta
of England and Wales and its Provinces Overseas
MEMBERSHIP APPLICATION FORM
To be completed by the Candidate for Installation, Joining or Re-Joining
This form must be completed using typescript or block letters and sent within fourteen days of admission of the candidate via the Provincial Vice -Chancellor to:
The Great Vice - Chancellor, The Chancery of the Orders, Mark Masons' Hall, 86 St. James's Street, London, SW1A 1PL
( Initials & Surname )
Data Protection Act 1998. I the above signed, hereby consent to the processing of personal data and information supplied on this form by the PRECEPTORY, PROVINCE and GREAT PRIORY
( ii )
( vi )
POSTCODE
9. DATE OF BIRTH
WORK
11. RAISED IN CRAFT LODGE
HOME
MOBILE
FAX
( Initials)
ON
DATE OF INSTALLATION
REASON FOR LEAVING Resigned, Honorary Member, Outer Guard, Ceased, Excluded, Warrant forfeited
DATEOF INSTALLATION
13. MMH MEMBERSHIP NUMBER
16. PRESENT PROVINCIAL RANK
15. PRECEPTOR OF PRECEPTORY
14. MOTHER PRECEPTORY
CONSTITUTION
(If not English)
NAME
DATED
I hereby certify that the above is a correct record
23. SIGNATURE OF REGISTRAR
22. NAME OF REGISTRAR
PLEASE GIVE DETAILS OF ALL THE PRECEPTORIES OF WHICH YOU ARE OR HAVE BEEN A MEMBER OVERLEAF
JOINING/RE-JOINING MEMBERS
ON
EXALTED IN ROYAL ARCHCHAPTER
10. TELEPHONE
( v )
( iv )
( iii )
( i )
8. ADDRESS
6. DECORATIONS AND HONOURS
5. FORENAMES IN FULL
4. COMPANION
(Surname)
7. STYLE OR TITLE
( e.g. Mr, Sir, Brigadier )
3. PROVINCE
2.
1. PRECEPTORY NAME
MEM
( Initials & Surname )
CONSTITUTION
(If not English)
CONSTITUTION
(If not English)
£00.00
DATE
DATE
GFDAR
DATE ADMITTED
*
* Admitted, Joined or Founder
DATE OF LEAVING
PRECEPTORY No.
DATE OF LEAVING
CONSTITUTION
PRECEPTORY No.
DATE OF LEAVING
DATE OF INSTALLATION
CONSTITUTION
PRECEPTORY No.
DATE ADMITTED
DATE OF INSTALLATION
CONSTITUTION
CONSTITUTION
DATE OF INSTALLATION
DATE ADMITTED
*
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*
**
*
**
DATE OF LEAVING
** REASON FOR LEAVING:- Resigned, Honorary Member, Outer Guard, Ceased, Excluded, Warrant forfeited.
CONSTITUTION
Any Additional Comments
DATE OF INSTALLATION
PRECEPTORY No.
DATE ADMITTED
CONSTITUTION
DATE OF INSTALLATION
DATE OF INSTALLATION
DATE OF LEAVING
DATE OF LEAVING
DATE ADMITTED
DATE ADMITTED
PRECEPTORY No.
PRECEPTORY No.
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Please give the numbers of all the Preceptories of which you are or have been a member together with the year of admission and if applicable
the date of Installation and / or the date of leaving.
CANDIDATE’S MEMBERSHIP DETAILS WITHIN THE ORDER
I, solemnly declare that I* been*
Signed: