Petition For Affiliation And Dual Membership By Affiliation Form
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1Petition for Affiliation
and Dual Membership by Affiliation
_________________________20__________
To the Worthy Matron, Officers and Members of____________________________Chapter No__________
Order of the Eastern Star:
The undersigned, late a member of______________________________Chapter No____________
Of_____________________________, solicits affiliation with your Chapter. If this petition be granted,
___he pledges____self to a cheerful obedience to the laws of the Order.
How long have you lived in this Jurisdiction?____________________________________________________
Present Address?____________________________________How long?_____________________________
Church Affiliation?___________________________________Location?_____________________________
Occupation?________________________________________Where Employed?_______________________
Employers name and address________________________________________________________________
Have you petitioned any other Chapter and been rejected?__________________________________________
If so, when and where?_____________________________________________________________________
History of Membership
When Initiated?______________________Chapter Name____________________________No___________
City____________________________________________________________________________________
If you have transferred membership since being initiated please give:
Date of Demit______________from_____________Chapter No_______City__________________________
Date of Affiliation_____________to_____________Chapter No_______City___________________________
If more than one transfer of membership has been made, give information on back of this form.
Give names and addresses of three references who have known you for some time.
Name
Occupation
Address
________________________
_____________________________
____________________________
________________________
_____________________________
____________________________
________________________
_____________________________
____________________________
Affiliation Fee Attached
$__________
Signed___________________________________
Recommended by:
Street____________________________________
________________________
City_____________________________________
________________________
…………………………………………………………………………………………………………………………………………………………………………………….
Committee on Character
____________________________________
____________________________________
____________________________________
Report of Committee on Character
The undersigned, your committee appointed to investigate and report upon the foregoing petition for restoration,
Respectfully state that we have discharged the trust confided in us and report _____favorable.
________________________________________
________________________________________
________________________________________
Rev 12/20/2011
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