Illinois Jurisdiction Membership Reporting

Organization:  DeMolay Sweetheart Court Squires

Chapter*: Location*:

New Member Information

Member's Name*: Last Middle Name First Name

Mailing Address*
    Address 1:
    Address 2:
    City: State Zip

Phone Numbers*
    Phone 1:
    Phone 2:

E-mail Address:

Birthdate:

Initiatory Degree Date: DeMolay Degree Date:

Member was  Obligated only. Given full degrees.

First Line Signer ID Number: Name:

Second Line Signer (or Sweetheart Court Member) Name if applicable:

Parent Information

Parent's Name*: Last First

Mailing Address*
Address 1:
Address 2:
City: State Zip

Phone Numbers*
Phone 1:

Father:  Senior DeMolay Master Mason Both Neither

Advisor Information

Name:

Mailing Address*
Address 1:
Address 2:
City: State Zip

Email Address*

Comments:

Please verify all information is correct then click Send