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Mark Master Mason and Royal Ark MarinerExit Form (Confidential)
Please complete this form whenever a member resigns from a Mark Master Mason or Royal Ark Mariner Lodge
Mark Degree ☐ Royal Ark Mariner Degree ☒
Lodge Name Click or tap here to enter text. Lodge Number Click or tap here to enter text.
Reason (Check Applicable Box)
Resigned ☐ Ceased Membership ☐ Excluded ☐ Deceased ☐ Honorary ☐
Members Details MMH ID Number Click or tap here to enter text.
Surname Click or tap here to enter text.
Forenames Click or tap here to enter text.
Address Click or tap here to enter text.
Click or tap here to enter text.
Click or tap here to enter text.
Click or tap here to enter text. Post Code Click or tap here to enter text.
Date of Advancement, Elevation or Joining Click or tap to enter a date.
Date of leaving Click or tap to enter a date.
Reason for Resignation (please check any that apply) Underline main reason
☐ Change of Employment, making attendance difficult
☐ Family Commitments
☐ Financial Problems
☐ General Loss of Interest
☐ Pressure of progress in office, learning ritual or attending meetings
☐ Inadequate disabled access provision at the meeting place or health difficulties
☐ Lack of transport
☐ Friction, disharmony within the lodge or an individual
☐ Times and dates of meetings
☐ Unable to contact member at last known address
☐ Other (please complete page 2)
Would he consider joining another Lodge ? (Please check as appropriate)
Yes, in this Province ☐ Yes, in another Province ☐ No ☐
Signed Secretary / Scribe
Signed Worshipful Master / Commander
Date Click or tap to enter a date.
Please return completed form to the Provincial Grand Secretary, email to [email protected]
Mark Master Mason and Royal Ark Mariner
Exit Form (Confidential)Additional Information
Click or tap here to enter text.