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__________

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__________