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Ramapo Lodge #485 Knights of Pythias
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Application for Membership

Applicant Name: _________________________________


              KNIGHTS of PYTHIAS

                                Application for Membership

To  Ramapo Lodge                         Lodge No.  485

Knights of Pythias of   Rockland County



                                I respectfully apply for membership in your lodge by




                I declare upon honor that I believe in a Supreme Being, that I am not a professional gambler, or unlawfully engaged in the wholesale or retail sale of intoxicating liquors or narcotics; and that I believe in the maintenance of order and the upholding of constituted authority in the government in which I live. Moreover, I declare upon honor that I am not a Communist or Fascist;  that I do not advocate nor am I a member of any organization that advocates the overthrow of the Government of the Country of which I am a Citizen by force or violence or other unlawful means; and that I do not seek by force or violence to deny to others their rights under the laws of such country.


I was born in the City of _____________________________________

State, province or Country of _________________________________

On the ______ day of ______________________________, 19______

I am a citizen of (name of country) _____________________________

Residence (P.O. Address) ______________________________ Phone No. (___)_______ City /State/ Zip Code __________________________________

Occupation __________________________________________

Business address ______________________________________


                If this application be granted, I promise a full and faithful observance of all the laws that may govern this lodge and the Order.


                The fee of $____45______ accompanies this application.


                Written and signed by my own hand this _______________day of _______ 20__


                Signed ________________________________________

                                Signature of Applicant


                We, the endorsers of the above applicant certify that the applicant posses all of the necessary qualifications for membership in the order Knights of Pythias.


                Signed ____________________________  _________________________________

                                Endorsers of Applicant


Print out and mail in to:
Louis Schaffer
17 Long Valley Drive
Nanuet, New York 10954