To The Worshipful Master, Wardens and Brethren of
Amity Lodge #323 F. & A. M.
Date____________________________20______
The undersigned, unbiased by the improper solicitation of friends, uninfluenced by mercenary or other unworthy motives and prompted by a favorable opinion and a desire for knowledge of our Ancient and
Honorable institution, Freely and voluntarily offers himself a candidate for the mysteries of Freemasonry and respectfully petitions for initiation and advancement in our Lodge, promising a cheerful conformity to the ancient usage and customs of the Order, and upon his honor has made true answers to the following questions.
Note--- The petition MUST be filled out by the petitioner in his own handwriting (legible). Type or hand Print.
Initiation fee is $250.00 $125.00 to be submitted with application and balance prior to First Degree.
1. What is your full name? __________________________________________________________________
2. Where were you born?____________________________________________________________________
3. What was the month, day and year of your birth?_______________________________________________
4. Where do you reside?_____________________________________________________________________
_______________________________Zip______________ Tel. No._______________________________
4a What is your email address? _______________________________________________________________
5. Where have you resided for the twelve months last past? ____________________________________
______________________________________________________________________________________
6. Do you believe in the existence of one ever living and true God?___________________________________
7. Do you believe in the immortality of the soul? _________________________________________________
8. Have you ever been convicted of a crime, irrespective of whether sentence has been suspended? _______
If so, state the facts concisely______________________________________________________________
9. Have you ever presented a petition to a Masonic Lodge, either in this State or elsewhere? ______________
If so, when and to what Lodge?_____________________________________________________________
10. Have you ever been rejected by a Masonic Lodge, either in this State or elsewhere?___________________
If so, when and by what Lodge?____________________________________________________________
11. Where have you resided for the ten years last past? If in more than one place, state the particular years in each place. _______________________________________________________________________________
12. What has been your business occupation for the 10 years past? State explicitly, specifying particular years and where conducted. _______________________________________________________________________
13. Have you read all of the foregoing questions? _________________________________________________
14. Are all of the foregoing answers in your own handwriting? _______________________________________
15. Do you, upon your honor, declare all of your answers to be true? __________________________________
Signature of Petitioner_________________________________________
Presented by Brother__________________________________________________________________of the above Lodge, who hereby certifies that he is well acquainted with the petitioner, he has read the answers to the questions contained in the petition and believes them to be true and that the petitioner is of good character and reputation, and comes under the tongue of good report.
(OVER)

REFERENCES
Please note that the personal references may be contacted by members of a committee by mail, phone or personal visit. Be sure to supply complete mailing addresses and phone numbers for each reference.
Sponsor may not be used as reference.
Name__________________________________________ Home Phone ________________________
Address___________________________________________________________________________
Name__________________________________________ Home Phone ________________________
Address____________________________________________________________________________
Name__________________________________________ Home Phone ________________________
Address____________________________________________________________________________
USE THIS SPACE IF NEEDED TO COMPLETE QUESTIONS ON REVERSE SIDE
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Initiation Fee Collected
For Lodge Use Only
__________________ Date _______________________
Committee Members: ____________________________ _________________________________
____________________________________________

Free and Accepted Masons
71 West 23rd Street Box L2
New York, NY 10010
To the Worshipful Master and Brothers of Amity Lodge #323.
I _____________________________________ have applied for membership in this Masonic Lodge. In addition to the questions already answered in the application, I accept the following obligations for membership:
1.
I understand that my annual dues must be paid immediately upon receipt of invoice
2.
I understand that I am required to attend ALL regular meetings of the Lodge.
3.
I understand that the regular meetings of the Lodge are held on the 2 nd Thursday of each month unless otherwise informed.
4.
I understand that I may be required to attend special meetings and practices of the
Lodge upon due notice.
5.
I understand I will be required to learn to recite from memory certain sections of
Masonic education that I receive.
6.
I understand that I will not be advanced further in Freemasonry until such time as
I have proven my proficiency in my previous Degree.
By my signature below, I declare upon my honor that I will abide by these rules and regulations as well as any others that may come to my knowledge.
_________________________________________ ______________________
Signature DATE:
_____________________________________________
Sponsor