Masonic Yacht Club, Inc.

Meeting at Bedell’s at West Wind

104 E. Bedell St., Freeport, NY 11520 – (516) 546-4545

Application for Membership

 Last Name:: __________________________________   First: : ____________________   M.I.: _____

Your Date of Birth:: _____/_____/_________   Spouse’s Name:: ______________________________

Home Address:: ____________________________________________________________________

City: ___________________________________   State: ________            Zip + 4: ________________

Home Phone w/area code (_____)_______________   Home Fax w/area code (____)________________

Cell Phone w/area code (_____)_______________   E-Mail: ___________________@______________

Pager w/area code (_____)_______________    Car/Boat Phone w/area code  (_____)_______________

Business Name: ____________________________________________________________________

Business Address: __________________________________________________________________

City: ___________________________________   State: ________            Zip + 4: ________________

Work Phone w/area code (_____)_______________   Work Fax w/area code  (_____)________________

Masonic Lodge Name & Number: _______________________________________________________

Lodge Address/District: _______________________________________   Meets on: ______________

Your Masonic Title (Bro., Wor., VW, RW, MW): ___________  DSA?: ________ Date Raised: ___________

Your Grand Lodge ID Number (found on your Dues Card): ______________________________________

Do you own a boat?: ________ Where is it moored?: _______________________________________

Please describe it: ___________________________________________________________________

__________________________________________________________________________________

Initiation Fee = $100.00.  Please enclose a copy of your current
 MASONIC LODGE DUES CARD
& a check in the amount of $100.00, made payable to Masonic Yacht Club;  Mail to:

Robert Stein, Secretary
57
Calvert Avenue
W.
Babylon, NY 11704

(631) 422-6559
 

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