| PETITION FOR INITIATION
AND MEMBERSHIP | |
| SYRIA SHRINERS, A.A.O.N.M.S |
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| TO THE POTENTATE, OFFICERS AND NOBLES OF SYRIA SHRINERS
A.A.O.N.M.S |
| SITUATED IN THE OASIS OF CHESWICK, DESERT OF PENNSYLVANIA |
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| I, the undersigned, herby declare that I am
a Master Mason in good standing in_________________Lodge #___________ |
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| located at________________________________________________________ _________________________________ |
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City |
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State |
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| which is a Lodge recognized by the or in the
Conference of Grand Masters of North America. Further more, I have resided |
| at my current address for not less than 6 months,
as required by the Bylaws of The Imperial Council. I respectfully pray |
| that I may be made a Noble of the Mystic Shrine,
and become a member of your temple. |
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| If I be found worthy, and my request granted,
I promise to conform to the Articles of Incorporation and Bylaws of The |
| Imperial Council and the Bylaws and Ceremonies
of your temple. |
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| Birthplace_________________________________________________________________
Date of Birth_______________ |
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| Profession or occupation_____________________________________________________
Retired____________________ |
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| Are you now a member of the Scottish Rite or
York Rite? |
Yes |
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No |
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| Were you ever a member of the US Military? |
Yes |
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Specify |
_____________________ |
No |
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| Have you previously applied for admission to
any Shriner's organization? |
Yes |
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No |
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| If so where? _____________________________________________________ |
When |
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| Residence Address |
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_______________ |
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County |
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Zip Code |
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Phone |
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| E-Mail Address ________________________________ |
Hat Size |
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| Wife's Name __________________________________ |
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Print |
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| Signature |
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Date |
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20______ |
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| Print Full Name Here |
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Name in Full (Initials not sufficient) |
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| Recommended and Vouched for on the Honor of: |
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| Noble |
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Card No. |
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Unit/Club |
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| Noble |
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Card No. |
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Unit/Club |
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| 2006 Fee $175.00 Includes Initiation Fee, Jeweled
Fez(2006 pro-rated dues and 2007 dues, Imperial and Hospital assessment) and a |
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| scheduled bus trip and lunch for Candidate and
Guest to Erie Shriner's Hospital for Children. |
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| Total Fee to accompany petition |
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| Make check payable to: Syria Shriners, A.A.O.N.M.S.
1877 Shriners Way Cheswick, PA 15024-1075 |
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