5th_district_application

The Fifth Masonic District Association of Manhattan

71 West 23rd Street, New York, NY 10010

District Association Membership Form 2024
Masonic Title:

R.:W.:V.:W.:W.:Bro.
Name
Birthday
Spouse
Lodge Name
No
Lodge Officer Title
Date Raised

MonthDayYear
Date
Address
Apt
City
State
Zip Code
Email
example@example.com
Occupation
Business Location
Sponsored by
Applicants Signature

Clear
Date

MonthDayYear
Date
Dues Paid
Received by
Remarks to Note:________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________
Please forward this Application Form and Membership Dues to our Corresponding Secretary: Greg Feldman, 263 Mineola Blvd, Mineola, NY 11501 Annual Membership Dues is $20.00 (Life Membership is $200.00 after 12/31/21 Check is payable to: "The Fifth Masonic District Association of Manhattan". Email Application to: gregfeldman114.comThank you for supporting and joining the 5th Manhattan District Association

5th District Association Membership Form - Revised September 2024
Should be Empty: