INTERNATIONAL MASONIC ORDER “DELPHI”
APPLICATION FOR ADMISSION
Date: ____________
Print out, complete and send to:
Victoria Karpos, Secretary
Athena Lodge
947 West Folsom Ave.
Salt Lake City, Utah 84104
Ladies and Gentlemen:
I hereby have the honor to request your approval for my admission to the Venerable Lodge ATHENA.
Personal Data:
Family Name _______________________________________________
Name(s) _______________________________________________
Profession _______________________________________________
Birth Data:
Date: ____________________
Place:____________________________________________
Personal I.D. Card ( i.e. Driver's License Number or Passport Number)
Number ________________ Authorities _________________________________________
Parents’ Data
Father’s Name _________________________ Mother’s Name _______________________
Family
Married/Single/Widower/Divorced: ____________________________________________
Children (number, age, sex): ___________________________________________________
Permanent Residence
Address: ____________________________________________________________________
Zip Code __________ City, County, State: _________________________________
Phone(s) ____________________________________________________________________
Professional Data
Name of Company ____________________________________________________________
Position in the Company ______________________________________________________
Address ____________________________________________________________________
Zip Code ____________ City, County, State _____________________________________
Phone(s) ____________________________________________________________________
Academic and individual education
Schools, Colleges, Faculties, Universities and Certificates thereby ____________________
____________________________________________________________________________
Foreign Languages ___________________________________________________________
Other interests _______________________________________________________________
____________________________________________________________________________
Personal Beliefs
Do you believe in the freedom of thought, of speech and of conscience?______________
Do you believe you have done your duty to your fellow man? _______________________
What is your purpose or desire to be admitted in Free Masonry? ____________________
__________________________________________________________________________
Other information
Have you ever made an application to another Lodge? When was that? _______________
How can one meet you? ______________________________________________________
Do you know Free-Masons? Who are they? ______________________________________
(Family name/name(s)/phone(’s) _______________________________________________________________
Mention friends of yours, not Free-Masons, who can give information about you.
(Family name/name(s)/phone(’s) _______________________________________________________________
___________________________________________________________________________________________
I hereby certify all the above mentioned information to be true and correct.
Honorably
Signature
This Application is supported by: (Family name/name(s)/signature)
1. ________________________________________________________________as sponsor
2. ________________________________________________________________
