Application for Membership

APPLICATION FOR MEMBERSHIP OF A MASONIC LODGE IN SOUTH AUSTRALIA AND NORTHERN TERRITORY
To the Worshipful Master and Brethren of
Lodge Number & Name(Required)
Click below to drop down the list.
on the register of the Grand Lodge of Antient, Free and Accepted Masons of South Australia and Northern Territory ('Grand Lodge'), I,
Name(Required)
Enter your name in full in the box below
Hereby apply to become a member of your Lodge.
I am a free man of at least 18 years of age, affirm my belief in a Supreme Being, and declare that, if admitted, I will cheerfully conform to all the antient usages and established customs of the Order.(Required)
- I agree
I accept that conformity to the Federal and State Laws of Australia and upholding the interests and prosperity of the State and Country by promoting peace and cultivating harmony and brotherly love, are essential qualifications in Freemasonry.(Required)
- I agree
I acknowledge and agree that I will be required to supply a National Police Certificate for the purpose of Freemasonry in South Australia and the Northern Territory using the organisation's own form (please download underneath) in support of this application and that a copy of the said Certificate will be provided to the Grand Lodge before I can be admitted.(Required)
- I agree
Click here to download the National Police Check application
I acknowledge and understand that under our regulations, there is a positive obligation to inform the Grand Secretary immediately if I become guilty of a Masonic offence.(Required)
- I agree
I consent to a police check and agree to self-report any past, present, or future criminal offences, including any pending charges yet to be resolved.(Required)
- I agree
Failure to self-report compounds the offence to the point where penalties must be applied. However, if I self-declare and provide an explanation of the circumstances, a note will be made, and that may be the end of the matter as part of the positive reporting requirements.(Required)
- I agree
By ticking this box, I accept this responsibility as an integral part of my membership obligations. I have read the information provided to me and understand that Freemasonry offers no pecuniary benefits to its members. I am fully informed of the financial obligations I should incur if admitted.(Required)
- I agree
Date of Birth(Required)
DD slash MM slash YYYY
Place of birth(Required)
Wife / Partner name / Single(Required)
Residential address(Required)
Residential State(Required)
Residential Postcode(Required)
Telephone number(Required)
Land line or mobile
Postal address
If postal address is different to residential, please fill in details. If it is the same, please leave blank
Postal State
Postal Postcode
Email address
Profession
If retired please write retired
Do you wish to receive our e-newsletter?(Required)
- Yes
- No
Have you ever made application to be a member of any other Freemasons' Lodge?(Required)
Please provide details(Required)
Are you, or have you ever been in any way connected with any organisation imitative of Freemasonry or any Masonic Order which is not recognised by the Grand Lodge?(Required)
Please provide details(Required)
Have you ever been found guilty by a Court or other tribunal having lawful jurisdiction over you, of any offence that carries with it a finding of dishonesty or criminal liability (including any offence that is listed or not listed in the National Police Certificate that has been or will be provided)?(Required)
Please provide details(Required)
Are you, or have you ever been, a member of any organisation that: 1. is involved in, or has been identified by any Federal or State law enforcment agency as being involved in, any activity or conduct that offends Federal or State criminal legislation or codes;(Required)
- Yes
- No
2. has been, or is, the subject of investigation by any Federal or State law enforcement agency,(Required)
- Yes
- No
3. has been, or is, the subject of adverse criticism in the public domain by any Federal or State law enforcement agency because a high percentage of its member base has been the subject of criminal charges or convictions for criminal offences;(Required)
- Yes
- No
4. has been the subject of an application or declaration made under any Federal or State based Serious and Organised Crime Legislation?(Required)
- Yes
- No
Please provide details(Required)
I declare that my answers to the above questions are correct in every particular.
Dated(Required)
DD slash MM slash YYYY
Witnessed by a member of Freemasonry SA & NT
Freemason Witness Name(Required)
Enter your name in full in the box below
Freemason Witness Lodge Number & Name(Required)
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We the undersigned propose that
Applicant Name(Required)
be accepted as a member of
Lodge Number & Name(Required)
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We declare that as proposer and seconders we have been Master Masons of more than twelve months and that we have known the applicant personally for more than twelve months.
Select below
- we have known the applicant for a period of not less than 12 months from the date of application
- we have NOT known the applicant for a period of more than 12 months from the date of application and require a dispensation
Proposer(Required)
Enter Proposer name below
Proposer Lodge Number & Name(Required)
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Provide lodge details
Dated(Required)
DD slash MM slash YYYY
Seconder(Required)
Enter Seconder name below
Seconder Lodge Number & Name(Required)
Click below to drop down the list.
Provide Lodge Details
Dated(Required)
DD slash MM slash YYYY
Human Check

APPLICATION FOR MEMBERSHIP OF A MASONIC LODGE IN SOUTH AUSTRALIA AND NORTHERN TERRITORY