FMV Membership Application

Application for Membership - Second Schedule Form A

Complete the form below to apply to become a Freemason in Victoria. Please note that the Lodge name and number are left intentionally blank when you are new to Freemasonry
Title (Mr, Dr, Prof, etc)
Name in Full

First NameLast Name
Post Nominals (Such as OAM)
Date of Birth*

DayMonthYear
Age*
You must be over 18 to become a Freemason
Home Address*

Street Address

Street Address Line 2

CityState

Post Code
Phone*

Area CodePhone
E-mail*

Confirmation EmailYour email will be used to grant you access to member only areas of the FMV website, including the Masonic Advancement Program and receiving our weekly newsletter
Occupation*
Employer Name
If applicable
Employer Address

Street Address

Street Address Line 2

CityState

Post Code
Employer Phone

Area CodePhone Number
Emergency Contact*
Spouse/Partner (if applicable)
Emergency Contact Phone*

Area CodePhone Number
Relationship to you
Children (so we can include you in family days focused on children)
If applicable

Rows	Years	Months
How long have you resided in Victoria immediately preceding your application?
How long have you resided at your present address?

Application Processing Fee*

Application Fee$49.00AUD

Total $0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

This Application Processing Fee is deducted from your initial membership dues on successful application to become a Freemason.

To the Worshipful Master, Officers and Members of the

Lodge No. ______________________________

I, {name}, being eighteen years or older prior to my initiation, acknowledge my belief in a Supreme Being and offer myself as a candidate for Freemasonry.

I further:
- affirm that my desire to become a Freemason is absolutely voluntary;
- affirm that no person has unduly influenced me to offer myself as a candidate;
- recognise that Freemasonry is not a means to professional or social advancement;
- am aware that the practice of charity is a central aspect of Freemasonry;
- agree to conform to all lawful authority and abide by all applicable laws, ordinances and regulations of Australia;
- am aware of and accept the financial obligations that will be placed upon me as a member of Freemasonry;
- affirm that the financial obligations of Freemasonry will not cause undue hardship to myself or my dependents;
- understand that failure to fulfil my financial obligations to Freemasonry may result in my exclusion from membership;
- understand that, as a member, failure to act in accordance with the rules, regulations and practices of Freemasonry will also reflect poorly on my proposer and seconder
I declare on my honour that all the information supplied by me on this form is true and correct in every particular.

I hereby authorise Freemasons Victoria to maintain and use personal details supplied by me for the keeping of records and provision of services during my period of membership with the organisation.
Signature of Candidate*

Clear
Date

DayMonthYear
Date
Declaration of Privacy

Freemasons Victoria Pty. Ltd. acknowledges and respects the privacy of individuals. Any information collected by Freemasons Victoria Pty. Ltd. from membership applications, registrations and the like will be used to keep you informed as to the ongoing activities of the organization and to assist us in improving our services to you. Information collected will be entered into a database that is owned and operated by Freemasons Victoria Pty. Ltd. and this information will be updated progressively in an effort to keep your personal records accurate. The provision of the information is voluntary, but if this information is not provided, Freemasons Victoria Pty. Ltd. may be unable to process your application, registration or enquiry.

You have a right of access to, and alteration of personal information concerning yourself in accordance with the Information Privacy Act 2000. The information collected by Freemasons Victoria Pty. Ltd. will be held by Freemasons Victoria Pty. Ltd. and will not be communicated to a third party outside Freemasonry without your specific authority.

Please direct any enquiries you may have in relation to this matter to the Grand Secretary. Telephone: (03) 9411 0111 Email: grandsec@freemasonsvic.net.au
PROPOSER AND SECONDER

We propose the above-named gentleman as a candidate for Initiation into Freemasonry

Proposer: __________________________________

PRINT NAME IN FULL

Lodge No.: ______

Seconder: __________________________________

PRINT NAME IN FULL

Lodge No.: ______

Dated this _____________day of ____________________ 20 _____________

Proposer's Signature: ___________________________________________

Seconder's Signature: ___________________________________________

FOR LODGES SECRETARY'S USE ONLY

___________________________________________ Date ________   20_____

___________________________________________ Date ________   20_____

___________________________________________ Date ________   20_____

___________________________________________ Date ________   20_____

___________________________________________ Date ________   20_____

___________________________________________ Date ________   20_____
Company
Prospect Status
Lead Status
Prospect Status
Should be Empty:

Rows	First Name	Last Name	Email Address	Phone Number
Referee 1
Referee 2
Referee 3
Referee 4

Application for Membership - Second Schedule Form A