Petition for Affiliation About UsFAQsMembershipAlaska Lodge of Research and Education HonorsPetition for AffiliationPublicationsArticlesMeetings, Events, & Online Forum Petition for Affiliation – R&E Petition for Affiliation or Dual Membership * Affiliation Dual Membership To the Worshipful Master, Wardens and Brethren of the Alaska Lodge of Research and Education No. 25, Free and Accepted Masons of Alaska, I, * I, First First Middle Middle Last Last the petitioner, reside at * the petitioner, reside at the petitioner, reside at the petitioner, reside at City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Email * Date of Birth * Place of Birth * I was Initiated on * Passed on * Raised on * in * Lodge Name Lodge No. * Located at * in the State/Province of * and am now a member in good standing in * Lodge Name Lodge No. * located in * in the State/Province of * My dues are paid to * A Dimit or Certificate of good standing accompanies this petition (if membership is being retained in more than one lodge, a letter or certificate of good standing must be furnished for each lodge in which membership is being retained). At the present time I have membership in the following lodges in this or another Jurisdiction. * List the lodges where you maintain membership. Branch of Military Service Date of Marriage Place of Marriage Wife’s Maiden Name Wife's Maiden Name First First Middle Middle Last Last Names and Addresses of three next of kin * If this Petition is for dual membership, I thoroughly understand that I must maintain good standing in ALL Lodges, and that loss of membership or good standing in one Lodge may jeopardize my membership in any other. I plan on retaining my membership in * and all other Lodges in which I have membership in other Jurisdictions. Date * Signature To be signed at the Lodge Recommended by * Recommended by * Recommended by * Submission of Original Work * Drop a file here or click to upload Choose File Maximum upload size: 516MB Dates of: Reception: Report: Balloting: Result of Ballot: Petitioner Notified: Signed Bylaws: If Petition was declined, refund was sent on: Fees: Affiliation Fee: $100 Dues for Current Year: $130 Total: $230 Referred to Brothers: If you are human, leave this field blank. Submit Δ