APPLICATION

Order Sons of Italy in America

Monterey Lodge #2003

Date of Application:___/___/___

Applicant's Last Name:____________________ First Name:_________________

Street Address:____________________________ City:________________State:____________

Zip Code:_________ Home Phone:___-____-_______Sex:___ Social Security No:___________

Member Class:___ (Regular=R, Associate=A, Social=S, Junior=J)

Proponent's Name:___________________________Proponent's Lodge Number:________

Proponent's Member number:___________Proponent's Lodge Name:______________________________

Swear, upon my honor and upon my conscience, as follows:

1. That I have never belonged to any Lodge of the Order.(If this is not true, fill in the following two lines) That I have belonged to lodge_______________________________from which I was terminated on _________(date), for____________________________________________________________________

2. My occupation is (or if retired was) _______________________________________

3. That I am not a member of any organization dissenting from or opposed to this Order.

4. That I am Single___, Married___, or Widowed___ (check one)

SPOUSE'S NAME:__________________________ BIRTHDATE:______________ I have ____ children whose names and dates of birth are ________________________________________________________ ____________________________________________________________________

5. I am ___, am not ___ of Italian descent. My Spouse is___ is not___ of Italian descent.

6. Explain source of Italian descent:__________________________________________ _____________________________________________________________________

7. That I know of no reasons why I should not qualify to become a member of this Order.

8. That I believe in the Government of the United States and promise to obey and defend its Constitution and its Laws.

9. That I believe in the fundamental concepts of God and Country and do not profess any doctrine which tends to unlawfully subvert constituted government and authority.

10. That I am ___ am not ___ an American Citizen.

11. That I propose to become an American Citizen.

12. That I agree if initiated into this Order to familiarize myself with the Constitution and by-laws of this Order and to obey them as they exist at that time, or as they shall from time to time be amended.

13. That this application, when accepted in writing by the Grand Lodge of California shall constitute a formal contract between the Grand Lodge of California and myself.

14. Name of Beneficiary _______________________ Relationship to member ________