Legacy Life Member Certificate Application

Official Legacy Program Application

Legacy Life Member Certificate Application

Members complete this form themselves. It is submitted to the Supreme Grand Secretary for verification and issuance of a Legacy Life Member Certificate.

Who completes this form? Each member completes and submits their own application. All requests are subject to verification and approval by the Supreme Grand Secretary before a certificate is issued.

This form shall be completed by the subordinate Lodge/Chapter and submitted to the Supreme Grand Secretary for verification and issuance of a Legacy Life Member Certificate.

This field is for validation purposes and should be left unchanged.

Member Information

First Name(Required)

Middle Name

Last Name(Required)

Date of Birth(Required)

Member Email(Required)

The member’s own email address. Login details are sent here once the application is approved.

Legacy Life Member Is A(Required)

Brother

Sister

This determines which membership card design is issued.

Subordinate Lodge / Chapter

Lodge/Chapter Name(Required)

Lodge / Chapter Number(Required)

City(Required)

State/Country(Required)

Grand Jurisdiction

Grand Lodge / Grand Chapter Name(Required)

Grand Lodge / Grand Chapter Number

City(Required)

State/Country(Required)

Supporting Documentation

Upload supporting documents, if required, such as membership verification, lodge/chapter approval documentation, or officer certification.

Driver's License (required)(Required)

Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 10 MB.

Please upload a clear copy of your driver’s license or government-issued photo ID.