MERRITT LODGE NO. 168 - MEMBERSHIP INQUIRY FORM
Port Colborne, Ontario

Thank you for your interest in Freemasonry.
Please complete this form and email it to:
merritt.168.secretary@gmail.com

Date:

1) Full Legal Name:

2) Preferred Name:

3) Address:

4) Phone Number:

5) Email Address:

6) Date of Birth:

7) Occupation:

8) Have you previously applied to a Masonic lodge? (Yes/No)
If yes, please provide details:

9) Why are you interested in joining Freemasonry?

10) How did you hear about Merritt Lodge No. 168?

11) Are you available for meetings on the 2nd Monday evening
of each month (except July and August)? (Yes/No)

12) Optional references (name and contact):

Privacy Notice:
This inquiry form is collected only for membership follow-up and is
handled by authorized lodge officers. Do not include sensitive personal
data not requested above.