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The Pamphlet Collection of Sir Robert Stout: Volume 17

[application form]

To the Officers and Members of the Loyal............ Lodge, No......, A.I.O.O.F. of New Zealand.

Gentlemen,—Having conceived a favorable opinion of Odd-Fellowship, I respectfully ask to be initiated into the Order, and become a member of your Lodge.

My residence is...........; my age is..............years; my occupation is......................; born in........................

If admitted, I promise obedience to the usages and laws of the Order and of the Lodge.

Very respectfully, yours, ...................... Proposed and recommended by.............. Refers to