Application for Membership

First Name*

Surname*

Email*

Telephone*

Date of birth*

Marital Status*
—MarriedUnmarriedWidowedDivorcedCommon LawOther

Occupation*

City/Town (Where you live/work)*

Province (Where you live/work)*
—Eastern CapeFree StateGautengKwaZulu-NatalLimpopoMpumalangaNorth WestNorthern CapeWestern Cape

What languages do you speak?*
EnglishAfrikaansOther

Why would you like to become a Freemason?*

Please provide any other information about yourself that may be useful for us to know (e.g. your father or grandfather was / is a Freemason, etc.)*

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