Form No. 14 (Revised 2017)
RAOB
ROYAL
ANTEDILUVIAN
ORDER OF
BUFFALOES / / GLBC
GRAND
LODGE
OF
BRITISH COLUMBIA

Membership Nomination Form

( Please Complete the Form Using Block Letters )

Full Name of Applicant:______

Address:______

Postal Code: ______Phone No.: ______Cell No.: ______

E-mail: ______Date of Birth:______Nationality:______

Occupation:______

DECLARATION MUST BE SIGNED BY THE APPLICANT :

I, the above named Applicant, hereby declare as follows :

DATA PROTECTION ACT

(1)A record of every members admission to and activities within the Order and any other details or information which Grand Lodge of British Columbia (GLBC) shall in their absolute discretion deem relevant, relating to the Order (hereinafter called “Data”) may be stored in any computer designated by GLBC. Such data may be made available by GLBC to Provincial Grand Lodges or Minor Lodges, but shall be so disclosed only for the purpose of the Order, to assist in the efficient administration of its affairs. Upon becoming a member of the Order a person shall by this Rule, be deemed to consent to the storing and disclosure of such data and shall raise no objection thereto

(2)(a) that the particulars stated upon this Form are true

(b) that I am a true and loyal supporter of the British Crown and Constitution

(c) that my application is actuated by the desire to participate in the Philanthropic and Social Objects of the Order, and

that should I be accepted to membership, I do not expect to receive any pecuniary benefits therefrom

(d) that I have never been convicted of any criminal offence (other than a minor traffic offence).

Personal Signature of Applicant: ______

Provincial Grand Lodge of: ______

Lodge: ______No. _____

We, the undersigned, Members of this Lodge, do hereby propose, and second the above applicant to become a Member of this Lodge by initiation. The Applicant has been investigated by us in line with the

Guidance issued by the Grand Lodge Management Committee and is recommended for membership (to be completed only after interviewing the applicant by two members of the Investigation Committee)

Name of Proposer:______Signature:______

Name of Seconder:______Signature:______

The above named Candidate, was duly nominated
on the :______20______
(signed)______WP
(signed)______CM
(signed)______CS / We, the undersigned, hereby certify that the above named Candidate was duly and legally initiated a member of this Lodge on the:______20_____
(signed)______WP
(signed)______CM
(signed)______CS

After Initiation, this form, accordingly completed, to be sent immediately, together with the fees prescribed, to the Grand Secretary.

Form No 15 was forwarded to the Candidate
Date :______20_____
(signed) CS :______ / FOR GRAND LODGE USE ONLY :-
Credentials dispatched :
Date :______