Request for Restoration - Consuelo Lodge No. 325

First Name *

Middle Name

Last Name *

Email *

Phone Number *

Street Address *

City *

State *

Zip Code *

Birthdate *

Have you ever been arrested, taken into custody, pleaded guilty or no contest to, or been convicted of, a criminal offense other than a minor traffic violation? *

If yes, state fully all of the facts below, including date and place, the court or other public body disposing of the same, the sentence or other disposition made, and other pertinent facts. (Go to freemason.org/applicant for more information on the definition of a minor traffic violation. If you are not sure if a traffic violation is minor, please list it below.)

Highest Degree Obtained *

Date of Suspension (If Known)

I understand that if more than two years have passed since my date of suspension, a restoration request necessitates a two-thirds vote by ballot from all members present at the subsequent Stated Meeting following the submission of the request. *

I understand

I agree that in seeking restoration of my membership with the lodge, I acknowledge that I am required to pay dues in the amount of two years dues; the last calendar year and current calendar year, in full. *

I agree

I have never pled guilty or no contest to or been convicted of a crime of moral turpitude. (See explanation at freemason.org/applicant.) *

I swear