2021Bylaws

Form #5

PETITION FOR ASSOCIATE MEMBERSHIP 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 presently a member of Shriners, located at _ ____________________________________________________ being eligible under §323.10(a) for a demit, respectfully pray that I may be admitted as an associate member of your temple in accordance with §323.7. 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. 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 Birthplace

Signature _ __________________________________________________ Name in Full , initials not sufficient.

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

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