Membership application

Apply online below, or download the printable application for the membership you want. Men’s Lodge, Ladies Auxiliary, and Social membership each use a different form—use the PDF that matches your application.

Men’s Lodge — printable application (PDF)
Ladies Auxiliary — printable application (PDF)
Social membership — printable application (PDF)

Which membership are you interested in?

About you

Printable form for this membership:

Full legal name *

Date of birth *

Phone *

Email *

Street address *

City *

State *

ZIP *

Occupation / employer

Italian heritage / family town or region (if applicable)

Emergency contact & details

Emergency contact name

Emergency contact phone

Sponsor or member who referred you (if any)

How did you hear about the lodge?

Anything else we should know?

Review & submit

By submitting, you agree that the lodge may contact you about membership. This form is delivered by email and saved in the lodge's inquiry dashboard.

Your application includes personal information such as your contact details and date of birth. Submit only if you are comfortable sharing this information with Potenza Lodge through its FormBold inquiry service.

I confirm the information I provided is accurate to the best of my knowledge. *

Prefer paper? Download the application that matches your membership: Men’s Lodge, Ladies Auxiliary, or Social. Bring or mail it to the lodge. Questions: 303-477-1722.