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The Grand Lodge of Free and Accepted Masons of the State of Michigan
PLURAL MEMBERSHIP PETITION
To the Worshipful Master, Wardens, and Brethren of ___________________________________
Lodge No. ________ Free and Accepted Masons of Michigan:
The subscriber, a Master Mason, and now a member of __________________________________
Lodge No. ________ under the jurisdiction of the Grand Lodge of _________________________
respectfully petitions for Plural Membership in your Lodge; if found worthy, he pledges
himself to a cheerful compliance with the By Laws of your Lodge and usages and customs of the Fraternity and has been a Michigan resident for the last 12 months.
The Subscriber acknowledges that, if elected he shall be entitled to all of the rights and be subject
to all of the obligations of each Lodge to which he belongs, shall also be eligible to any office in the
lodge, except that of Worshipful Master. To be eligible to serve as Worshipful Master, he must
have been elected, installed and served as set forth in §4.16.1.6. Further, a Brother serving as
Worshipful Master in one lodge may not serve as Worshipful Master or Warden in another lodge.
Further, that suspension or expulsion from any Lodge shall have like effect in all other lodges,
Name:
MORI ID __________________
Residence is: _____________________________________________________________________
(must have been domiciled in Michigan for the last 6 months)
Date of Birth: __________________________ Phone: _____________________________
Month/Day/ Year
Home
Cell
Place of Birth: ___________________________________________________________________
(City/Town)
(State)
He received the degrees in:
Lodge No.
This jurisdiction must permit Dual/Plural Membership
In the State of __________________________________________
, as follows:
Initiated __________________ Passed ______________________ Raised ___________________
His dues are paid to: ____________
He has resided within the State of Michigan for 12 months preceding the date of his application: __________________________
Recommended:
Signed:
(Sign full name)
Date:
FORM NO.19 -­‐ AVAILABLE FROM THE GRAND LODGE OFFICE OR WWW.GRANDLODGEMI.ORG/FORMS/FORM19.PDF
(Revised 2016)
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