MEMBERSHIP INQUIRY FOR WESTERN HILLS-CHEVIOT LODGE

Thank you for your interest in becoming a Mason.  As you complete the following form, remember that Freemasonry prides itself by being open to all races, religions, and cultures.  We do, however, maintain the standards required by the Grand Lodge of Ohio in accepting applications from only men of good ethics and moral character who will uphold the reputation of the Masonic fraternity.  We also look for men who participate in Lodge activities as much as possible.

Unless the applicant is known by a member of the Lodge,  he must submit to a background check,  at his own expense,  prior to being reviewed by the Lodge Investigating Committee.

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NAME *

First

Middle

Last

DATE OF BIRTH *

*Required by Grand Lodge of Ohio. Petitioners must be at least nineteen years of age or over

EMAIL *

STREET APT/UNIT *

CITY STATE ZIPCODE *

PHONE NUMBER *

THIS IS MY *

• HOME
• BUSINESS
• MOBILE

ARE YOU A RESIDENT OF OHIO* *

• YES
• NO

*Petitioners must normally apply for membership in Lodges within their own state.

REASON FOR APPLYING FOR AN OHIO LODGE *

DO YOU BELIEVE IN THE EXISTENCE AND PERFECTION OF GOD?* *

• YES
• NO

*Required by the Grand Lodge of Ohio

HAVE YOU EVER PETITIONED ANY OTHER MASONIC LODGE, EVEN OUTSIDE OF OHIO? *

• YES
• NO

*Required by the Grand Lodge of Ohio

IF YOU ANSWERED YES ABOVE, WHEN, WHAT LODGE, AND WHAT WAS THE RESULT? *

HAVE YOU EVER BEEN ARRESTED OR CONVICTED OF A CRIME? *

• YES
• NO

*Required by the Grand Lodge of Ohio

DESCRIBE THE ARREST, DISPOSITION, AND ANY CONVICTION *

By Ohio Masonic Code, a felony conviction, and some misdemeanors, depending on the severity and type, normally disqualifies a man from becoming a Mason.*

WHY ARE YOU INTERESTED IN BECOMING A MASON? *

DO YOU KNOW ANY MEMBERS OF OUR LODGE OR HAVE ANY FAMILY OR FRIENDS WHO ARE MASONS? *

Persons not personally known to any member of the Lodge, must undergo a background check at his own expense, for a reasonable charge, as part of the investigation process.

DO YOU HAVE TIME TO PARTICIPATE? *

Will your job or family circumstances permit you the time to be an active and contributing member of the Lodge? Are there certain evenings that you are not available?

THE ABOVE ANSWERS ARE ACCURATE TO THE BEST OF MY KNOWLEDGE: *

FIRST * MIDDLE INITIAL * LAST

ACKNOWLEDGEMENT *

• By submitting this form I attest to the accuracy of the information provided. All information is considered confidential and will not be shared outside the Investigating Committee. I also acknowledge that becoming a Mason is not a right but a privilege and that Lodge’s decision whether allow a person to petition is solely at the Lodge’s discretion, based upon the standards and rules set by the Code of the Grand Lodge of Ohio.

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