Member InformationPlease use this form to request a new membership card if your DeMolay Jurisdiction is part of DeMolay International or you were a member of a Chapter in the Philippines prior to March 1985. If your membership is in a Chapter in Australia, Brazil, Canada or The Philippines (after March 1985), you will need to contact those Supreme Councils to acquire a new card. Requests received for cards from members of other Supreme Councils will be refunded less processing fees. If you have questions about your membership, please email us at DeMolay@DeMolay.org to verify if you should request a card using this form.Card Type:*DeMolay Membership CardKnighthood Membership CardSquire Membership CardReplacement Advisor CardID# Name* First Middle Last Date of Birth* DD slash MM slash YYYY Please enter the date in day/month/year format.Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of 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CareerJurisdictionAdriaticsAlabamaAlaskaArizonaArkansasArubaAustraliaBoliviaBrazilCanadaColoradoConnecticutDelawareDistrict of ColumbiaFloridaFranceGeorgiaGermanyIdahoIllinoisIndianaIowaItalyJapanKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern California & HawaiiOhioOklahomaOregonPanamaParaguayPennsylvaniaPeruPhilippinesRhode IslandRomaniaSouth CarolinaSouth DakotaSouthern CaliforniaSouthern NevadaTennesseeTexasUruguayUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingChapter Name Chapter Number Initiation Date DD slash MM slash YYYY Please enter the date in day/month/year format.Manor Name Squire Date DD slash MM slash YYYY Please enter the date in day/month/year format.Priory Name Knighthood Date DD slash MM slash YYYY Please enter the date in day/month/year format.Ebon Degree Date DD slash MM slash YYYY Please enter the date in day/month/year format.Honors Received CHEV LOH COH RD BHK PMC-MSA ChevalierSelect Year19501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020Legion of HonorSelect Year19501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020Cross of HonorSelect Year19501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020Representative DeMolaySelect Year19501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020Blue Honor KeySelect Year19501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020PMC-MSASelect Year19501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020New Membership CardPrice $0.00 *additional shipping charges for those outside the US.Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name CAPTCHA Δ
