At-Large Membership Application
Grand Lodge of Virginia
Order Sons of Italy in America

I, _________________________________________________________________________________________
hereby make application for regular at-large membership in the Grand Lodge of Virginia, Order Sons of Italy in America.

Address_____________________________________________________________________________________

              _____________________________________________________________________________________

Home Telephone # ________________________   Occupation ________________________________________
                             
E-mail Address _______________________________________________________________________________

Date of Birth:  ___________  Place of Birth:  ___________________________

If you were not born in Italy, give the name, relationship, and place of birth of your closest ancestor who was born in Italy:  

_______________________________________________________________________________________

I am o married  o single.  If married, spouse’s name _______________________________________________

Is spouse of Italian ancestry? _______        Are you a US citizen? __________

Have you ever been rejected by or expelled from a Lodge of the Order Sons of Italy in America? ____________
If answer is yes, give details (use back of form if necessary) ___________________________________________________

Upon my honor, I affirm that the information given above is complete and accurate. I acknowledge that any false statements will render the application void and may result in my expulsion as a member.

Date _______________   				_____________________________________________________
                					 (Signature of Applicant)

Date: ______________				_____________________________________________________
						(Sponsor, Financial Secretary or Membership Chair)

Grand Lodge of Virginia At-Large Membership Dues Structure

o Student At-Large Membership $20.00 per year. Full-time students between the ages of 18 and 25

Name of College/University __________________________________________________________________________

o     Regular At-Large Membership   $45.00 per year, plus one-time $10 initiation fee for members over 25. Applicant is at least 18 years of age or older and is not a full-time student.

At-large members may attend regularly scheduled meetings, receive all national & state publications, and participate in the social, cultural, and athletic activities of the Order. At-Large members may not be initiated, introduce motions, vote, or hold elective office. 

Mail your application and payment (payable to Grand Lodge of Virginia OSIA) to:
Jerry Hyatt, State Financial Secretary
Grand Lodge of Virginia, OSIA
5352 Sir Barton Drive
Virginia Beach, VA 23462

This application must be approved by the Grand Council of the Virginia Grand Lodge. Applicants will be notified in writing of action taken on their application.