APPLICATION FOR AFFILIATION
TO THE SOUTHERN CALIFORNIA RESEARCH LODGE

Date: _________________________

I respectfully represent that I am a Master Mason in good standing and do not stand suspended or expelled from any Lodge of Master Masons, and I hereby make application for affiliation in the SOUTHERN CALIFORNIA RESEARCH LODGE.

I am now a member in good standing of _______________________ Lodge No. ____ in the Jurisdiction of ________________________. Dues: $15.00 ($18.00) foreign per year (no affiliation fee).

For volume of SCRL papers add: $30.00 - USA (including Alaska & Hawaii); Foreign: $41.00 (includes cost of shipping and handling). [Postal Regulations are constantly changing and the cost of the SCRL papers is subject to change with varying postal rates.]

I reside at:

Street: _______________________________________________________

City, State, Zip: _________________________________________________

Telephone No. (_____)_______________; E-Mail ______________________

Signature__________________________________________(Sign name in full)

___________________________________________ (Print name in full)

Brother:

Membership in Southern California Research Lodge is based upon your being a member of a California Lodge or a Lodge recognized by the Grand Lodge, F&A M of California. Please, therefore, let us know the name and address of your Lodge Secretary so that we may verify your standing.

Lodge Secretary: _________________________________________

Address: _______________________________________________

City, State, Zip____________________________________________

Telephone No. (____)______________

MAIL TO: Norman B. Leeper 2097 Smokewood Ave, Fullerton, CA 92831