The Grand Lodge of Tennessee Free and Accepted Masons

TENNESSEE LODGE OF RESEARCH PETITION FOR MEMBERSHIP Date____________ To the Worshipful Master, Wardens and Brethren of the Tennessee Lodge of Research, F.&A.M. of Tennessee: I,_____________________________________________ (FULL NAME, NOT JUST INITIALS), at present a member in good standing of ______________________________ Lodge No._______, located at ______________________________ in the Grand Jurisdiction of ________________________________________________ Grand Lodge, certify that my dues are paid to and that no charges are pending against me, make application for dual/plural membership in your Lodge and, if elected, I promise to conform to all the ancient usages and regulations of the Fraternity. In the event the laws of the responding jurisdiction do not legalize and/or permit dual membership, then this application shall become null and void. Residence address (include zip): Residence phone (include area code): Business phone (include area code): Date of Birth_____________ (SIGN ALL GIVEN NAMES IN FULL) Presented (date):_________________ Elected:(DATE)________________ Rejected: (DATE) ______________ NOTES : INSTRUCTIONS: Petition must be completed in full. Send completed petition, a photocopy of your current Blue Lodge dues card, and $15.00 ($5.00 for fees. $10.00 for dues) to: Bro. George C. Ladd, Sec. 4521 Turkey Creek Road Williamsport, TN 38487