Texas Lodge of Research

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To submit your application to the Texas Lodge of Research:

Print this page and complete the information requested

Dues are $25 for individual membership; $20 for Associate status

Endowed Membership is $500 payable to the Texas Lodge of Research

Mail to:  Texas Lodge of Research, P. O. Box 684684, Austin, TX 78768-4684

If your petition IS NOT SIGNED by a Full Member of TLR, a Certificate of Good Standing from your Blue Lodge, AND/OR a photocopy of current Blue Lodge dues card AND a photo ID (drivers license, passport) MUST be attached.

Today’s Date:  _________________________________________________________________

Name:  _______________________________________________________________________

Address:  _____________________________________________________________________

City:  ____________________________ State: ___________ ZIP Code: __________________

Home No.: ______________ Business No.:  _________________ Cell No.: ________________

E-Mail Address: ________________________________________________________________

Date of Birth: _______________  Place of Birth:  _____________________________________

Name of your Blue Lodge: _______________________________________ No.: ____________

Blue Lodge City: _____________________ Blue Lodge State/Country: ____________________

Grand Lodge of ____________________________________________________(State/Country)

Are you a Past Master of a Blue Lodge?  ___ yes ___ no Which Lodge? ___________________

Are you a Current or Past Grand Master? ___yes ___ no  Which State? ____________________

Signature:  ____________________________________________________________________

HOW DID YOU LEARN ABOUT TLR?

_____  Recommendation of a current Full Member of TLR

                 Printed Name of TLR Member: ___________________________________________

                 TLR Member’s Signature: _______________________________________________

_____  TLR Brochure

_____  Internet via The Grand Lodge of Texas Home Page

_____  TLR Website

Office and Membership Committee Use Only

Date Rec’d

Check # or “CASH”

Date Entered

Ledger No.

Card & Welcome Ltr

Copy to MBR CMTE