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 * AffiliationDual 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 AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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 file 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