LIFE MEMBERSHIP APPLICATION
Grand Council of Cryptic Masons of the State of Illinois

I, Companion _______________________________________________________________
	                                                                       Print Name in full

residing at _________________________________________________________________

in the city of 	______________________________________________ and State of __________________

As a member in good standing of	 _______________________________________________

Council No. __________ 	located in the city of	 _____________________________________

and having paid the sum of $ ____________________ as required in the bylaws of 

said council do submit this application for Life Membership in that council.

Dated this __________ day of	 ____________________, 20__________.

I understand that should I forfeit my membership in my Lodge, Chapter or Council for any 

reason that the fees for Life Membership are not returnable.

Signed _____________________________________________ 

Please retain a copy for your council’s files and send a copy with the check made out to 

Grand Council of Illinois to 

Mark H. Welch
Grand Recorder
P. O. Box 676
Cuba, IL 61427-0676