I, , apply for membership to your Order, to the Officers and Members of
Please pick the closest city to you... Ancaster Amprior Aurora Aylmer Barrie Beachville Belleville Belmont Blenheim Bowmanville Bracebridge Brampton Brantford Brinston Brockville Brooklin Brucefield Brussels Burford Cambridge Campbellford Cayuga Chapleau Cobourg Collingwood Delhi Dresden Dundas Durham Dutton Elmvale Essex Etobicoke Exeter Florence Forest Gananoque Glanworth Glencoe Gravenhurst Guelph Hamilton Harrietsville Harrow Harrowsmith Havelock Huntsville Ingersol Ingleside Jarvis Keewatin Kemptville Kincardine Kingston Little Britain London Lyn Madac Melbourne Midland Millbrook Milton Mooretown Mount Brydges Nepean North Bay Oakville Oil Springs Orillia Orangeville Osgoode Ottawa Parham Parry Sound Peterborough Petrolia Picton Port Colborne Port Hope Port Perry Prescott Princeton Ridgetown Ruthven Sault Ste. Marie Shedden Simcoe South Mountain Springfield St. Catharines St. Marys St. Thomas Stratford Sudbury Tara Thamesford Thamesville Thessalon Thornbury Thunder Bay Tillsburg Tiverton Toronto Trenton Tweed Wallaceburg Wheatley Whitby Wiarton Williamsburg Woodslee Wyoming , Independent Order of Odd Fellows, working under the jurisdiction of the Grand Lodge of Ontario of the Independent Order of Odd Fellows.

     I respectfully request admission into your Lodge by initiation and I promise and agree that, if elected, I will conform to the Constitution and Bylaws of your Lodge and those governing the Grand Lodge of Ontario. I will seek remedy for all rights on account of said membership or connection therewith in the tribunals of the Order only, without resorting to their enforcement in any event, or for any purpose, to the civil courts.

     I believe in a Supreme Being and I am loyal to my country.

Sponsor (if any,): and Please pick your Sponsors Lodge I am not sure what it is Ancaster Amprior Aurora Aylmer Barrie Beachville Belleville Belmont Blenheim Bowmanville Bracebridge Brampton Brantford Brinston Brockville Brooklin Brucefield Brussels Burford Cambridge Campbellford Cayuga Chapleau Cobourg Collingwood Delhi Dresden Dundas Durham Dutton Elmvale Essex Etobicoke Exeter Florence Forest Gananoque Glanworth Glencoe Gravenhurst Guelph Hamilton Harrietsville Harrow Harrowsmith Havelock Huntsville Ingersol Ingleside Jarvis Keewatin Kemptville Kincardine Kingston Little Britain London Lyn Madac Melbourne Midland Millbrook Milton Mooretown Mount Brydges Nepean North Bay Oakville Oil Springs Orillia Orangeville Osgoode Ottawa Parham Parry Sound Peterborough Petrolia Picton Port Colborne Port Hope Port Perry Prescott Princeton Ridgetown Ruthven Sault Ste. Marie Shedden Simcoe South Mountain Springfield St. Catharines St. Marys St. Thomas Stratford Sudbury Tara Thamesford Thamesville Thessalon Thornbury Thunder Bay Tillsburg Tiverton Toronto Trenton Tweed Wallaceburg Wheatley Whitby Wiarton Williamsburg Woodslee Wyoming

Applicant Information:

Name:

I was born in on the 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st day of Select Month January February March April May June July August September October November December , 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 .

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Province: Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon      Postal Code:

Home Phone Number:     Email Address:
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Applicant's Signature:_____________________________
                                    To Be Signed at a later date.