I am interested in joining the Patriarch Militant

 I am a member of an Odd Fellow Lodge and an Encampment in good standing

First Name Last Name
Street Address City, State, Zip Code
Home Phone Cell/Work Phone
Email 1 Email 2

 
Additional Comments if desired (i.e. best time to contact, etc.): 

 

I understand that I am required to be a member of an Odd Fellow Lodge and an Encampment before I can petition a Canton for membership.