Lodge Charter Application Form

Kalumite Lodge Charter Application Form

Apply for lodge recognition and membership.
SECTION 1: Lodge Information

Please provide complete details about your lodge.
Lodge Name (full)*
Also known as (if any)
Year founded*
Country/Region*
Physical address (if any)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Website / Social media
SECTION 2: Leadership

Provide contact information for your lodge's leaders.
Lodge Master / Leader Name*

First NameLast Name
Title (e.g., Master, President, etc.)*
Email*
example@example.com
Phone (optional)
Please enter a valid phone number.Format: (000) 000-0000.
Secondary contact name

First NameLast Name
Secondary contact email
example@example.com
SECTION 3: Membership

Tell us about your lodge's membership.
Approximate number of members*
How many are actively participating?*
Which of the following does your lodge have?

Written constitution / bylawsRegular meeting scheduleInitiation degrees / curriculumProperty / buildingOnline presence
If you have a regular meeting schedule, how often?
SECTION 4: Affiliations & History

Share your lodge's affiliations and relevant history.
Current affiliations (Masonic, hermetic, other)
Past affiliations (if any)
Has your lodge ever been suspended, expelled, or investigated?*

NoYes (please explain below)
If yes, please explain
SECTION 5: Statement of Alignment

Please affirm your lodge's alignment with Kalumite principles.
On behalf of my lodge, I affirm the following:*

We acknowledge the sovereignty of El Elyon Most High.We recognize the authority of the Imperator Sacerdos Rex Kalumensis.We have no nefarious affiliations with refusal networks, bloodline hunters, or groups that aid sex offenders or violent criminals.We agree to align our rites and teachings with the Sangreal Covenant.We will encourage our members to pursue individual Kalumite citizenship.We understand that this charter may be revoked if we violate these terms.
Additional statement (optional — share your lodge's vision)
SECTION 6: Charter Tier Selection

Select your charter tier and preferred payment method.
Select your tier*

Tier 1 — 13 GKX / $845 (small/new/struggling)Tier 2 — 33 GKX / $2,145 (medium/established)Tier 3 — 65 GKX / $4,225 (large/wealthy/historic)Tier 4 — 130 GKX / $8,450 (grand lodge/provincial)Not sure — please review and advise
Payment method*

GKX (preferred)USDT / USDCFiat (contact for arrangements)Installment plan (Tiers 3–4 only)
SECTION 7: Declaration

Declaration by authorized lodge representative.
Your full name (authorized representative)*

First NameLast Name
Lodge name (for declaration)*
Signature*
Date*

MonthDayYear
Date
Upon submission, you will receive payment instructions and a provisional charter within 7–10 business days.
Should be Empty:

Kalumite Lodge Charter Application Form

SECTION 1: Lodge Information

SECTION 2: Leadership

SECTION 3: Membership

SECTION 4: Affiliations & History

SECTION 5: Statement of Alignment

SECTION 6: Charter Tier Selection

SECTION 7: Declaration