Grand Lodge of Illinois and Wisconsin
Order Sons of Italy in America
MEMBERSHIP APPLICATION
Lodge: Filippo Mazzei Greater Milwaukee Lodge #2763

Membership Type (check one):Regular Social (non-Italian) Youth (under 18 years old)

Membership Status (check one):New ($60) Renewal ($50) Youth($45) Renewal($35)
DATE:

PRINT FULL NAME:PLACE OF BIRTH: (city & state)

ADDRESS:CITY:STATE:ZIP:

DATE OF BIRTH:U.S.CITIZEN?:IF NOT WILL YOU BECOME A CITIZEN?

ITALIAN FAMILY NAME(S):MARITAL STATUS:(married or single)

ITALIAN HERITAGE ACQUIRED BY(check one):PARENT(S) MARRIAGE ADOPTION

DO YOU HAVE ANY CHILDREN? IF SO, HOW MANY? ARE THEY OSIA MEMBERS?

HOME PHONE: CELL PHONE: WORK PLACE:

EMAIL ADDRESS:

OCCUPATION:YEARS:

EMPLOYER NAME/ADDRESS:
SIGATURE 0F APPLICANT:
GRAND LODGE PRESIDENT:
OSIA SPONSOR:
SOCIAL MEMBERSHIP ONLY: I,________________________________, having been apprised of programmatic volintarily apply for SOCIAL Membership in Lodge #2763.
I disclaim any and all pecuniary benefits that the Grand Lodge provides for the Regular Members.
I do solemnly swear to obey and abide by the present laws and regulations of the Grand Lodge and by all those that may hereafter enacted.

Return this completed form along with your payment to:
(Payment payable to: Filippo Mazzei Lodge #2763)

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