2021Bylaws

Form #2

PETITION FOR AFFILIATION

SHRINERS

To the Potentate, Officers and Nobles of Shriners, Situated in the City of

, State of __________________________ : I, the undersigned, a Noble of the Order, initiated in ________________________ Shriners , located at on (date) and last a member of Shriners , located at , which has granted the attached Certificate of Demit, respectfully pray that I may be admitted a member of your temple. I furthermore state that I have resided at my current address for not less than six months, as required by the bylaws of Shriners International. I am a Master Mason in good standing in_ ____________________________________ Lodge, No._ ______ , located at _ ________________________________________________________ , or have otherwise met the prerequisites for membership under the bylaws of Shriners International. Birthplace Date of Birth Profession / Occupation ___________________________________________________________ Residence: _____________________________________________________________________ Street County City State Zip Business: _____________________________________________________________________ Street County City State Zip Mailing Address: _ _______________________________________________________________ (if different) Street County City State Zip Telephone: Res: Bus: Cell phone: Alt. phone: Email Address _ _________________________________________________________________ Name of Spouse _________________________________________________________________ Date 20

Signature _ __________________________________________________ Name in Full , initials not sufficient.

Print Full Name Here ___________________________________________________________ Recommended By _______________________________________________________________ Noble _____________________________________________________________________ Noble _____________________________________________________________________

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