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2008-2009 Council Members
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Membership Form ORDER SONS OF ITALY IN AMERICA (OSIA) GRAND LODGE OF FLORIDA MEMBERSHIP APPLICATION I, hereby apply for membership in the ____________________________Lodge #__________ of the Grand Lodge of Florida, Order Sons of Italy in America, Inc. (O.S.I.A.) Regular Membership_______ Social Membership______ Is this a Reinstatement _____Yes _____No Name__________________________________________ Email________________________ Address____________________________City_________________State_____Zip_________ Telephone: Home________________________ Business ____________________________ Date of Birth____________________ Place of Birth_________________________________ Married ___ Single ____ Widowed____ Name of Spouse ____________________________ Anniversary Month ________ Year______ Full Time Resident ___Yes ____No Past Italian Namesake_________________________ Occupation/Hobby_________________ Have you ever been convicted of a Felony? ____ Yes ____ No FOLD HERE FOLD HERE If accepted as a member, I agree to be bound by the present and future laws of the Supreme Lodge, of the Grand Lodge of Florida, and of the Lodge of which I become a member. I believe in the fundamental principle of God and country, and do not profess any doctrine which aims unlawfully to overthrow the social order or the organized government by force or violence. Applicant Signature____________________________________ Date____________________ ********************************************************************************* I affirm that I know the applicant and believe him (her) to be a person of good moral character and qualified to become a member of the Order. Sponsor Name(Print)____________________________________________________________ Sponsor Signature_____________________________________ Date____________________ Date Approved__________________ Date Initiated ___________________ Date Cancelled ______________ Date Accepted____________________ By______________________________________________________ State Financial Secretary ********************************************************************************** NOTE: Attach to Qtrly Report and forward to the State Financial Secretary for validation. A validated copy will be returned to the address below via email or U.S. Postal Service. Printed Name of Lodge Financial Secretary:____________________________________________________ Email Address:_____________________________ Street Address__________________________________ Telephone:____________________________ City:_________________________ State______Zip__________ |
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