Prospect Submission Form

Layout

First Name *

Chapter State/Province *

Member Status *

Last Name *

Chapter *

Out Date

If retired, on LOA, or out good or bad, please indicate date here.

Road Name *

Sponsor *

Office *

Birthday MM/DD/YY *

Patch In Date *

Secondary Office *

More About You

Layout (copy)

Email *

State/Province *

Occupation *

Motorcycle DL# *

Lodge of Record *

Phone *

International STATE or PROV

Marital Status *

Expires *

No. of Years *

Address *

Country *

Emergency Contact & Relationship *

Motorcycle Details *

Good Standing? *

City/Town *

Zip/Postal Code *

Emergency Phone *

What Makes YOU a good Free Runner?

What is your motorcycle skill level? *

How long have you been riding *

Have you ever participated in group rides? *

Have you been or are you currently a member of any other motorcycle organizations/clubs? *

What other Masonic bodies do you belong to? (i.e. Scottish/York rites, Shrine, etc.) *

Describe in your own words what "loyalty" means to you personally. *

Provide an example in which you personally implemented loyalty. *

What would you bring to the Free Runner table should you be patched in? *

Sponsor Details

SPONSOR RESPONSIBLE - Member Name *

SPONSOR RESPONSIBLE - Member Signature *

SPONSOR RESPONSIBLE - Date Signed *

VOUCHER 1 - Member Name *

VOUCHER 1 - Member Signature *

VOUCHER 1 - Date Signed *

VOUCHER 2 - Member Name *

VOUCHER 2 - Member Signature *

VOUCHER 2 - Date Signed *

Are You Ready to Sign On?

SIGNATURE OF APPLICANT *

I declare that the statements above are true and corrrect.

Date Signed *

Prospect Submission Form

FREE RUNNERS MASONIC ORDER WORLDWIDE

Petition for Consideration of Membership

More About You

What Makes YOU a good Free Runner?

Sponsor Details

Are You Ready to Sign On?