PETITION FOR INITIATION AND MEMBERSHIP

OASIS SHRINERS, A.A.O.N.M.S.

To: The Illustrious Potentate, Officers, and Nobles of Oasis Shriners, situated in the Oasis of Charlotte, Desert of North Carolina:

  I, the undersigned, hereby declare that I am a Master Mason in good standing in:

 _____________________________________ Lodge No.___________A. F. & A. M.

Located At:_________________________________________________________________________________

                                                         Number & Street    ~    City/Town   ~    State   ~   Zipcode

Lodge recognized by or in amity with the Conference of Grand Masters of North America.  Furthermore, I have resided at my current address for not less than 6 months, as required by the By-Laws of the Imperial Council.  I respectfully pray that I may be made a Noble of the Mystic Shrine, and become a member of your Shrine Chapter

If I be found worthy, and my request granted, I promise to conform to the Articles of Incorporation and By-Laws of the Imperial Council and the By-Laws and Ceremonies of your chapter.

Birthplace:             _______________________________________   Date of Birth:      __________________

Were you ever a DeMolay? ____________        If so, what chapter name & location? ____________________

Profession/Occupation:     _________________________________________________________________

Have you previously applied for admission to any Shrine chapter of the Order? _________________________

If so, where?         _________________________________

When?                   _________________________________

Residence:  ____________________________________________________________________________________

                                                         Number & Street    ~    City/Town   ~    State   ~   Zipcode

Mailing Address_________________________________________________________________________________

                                                         Number & Street    ~    City/Town   ~    State   ~   Zipcode

Business Address______________________________________________________________________________

                                                         Number & Street    ~    City/Town   ~    State   ~   Zipcode

Telephone______________________________________________________________________________

                                                         Home Phone Number          ~           Business Phone Number

Email Address:  ________________________________________________________________________

Spouse's Name:  ____________________________Your Hat Size:________________________________

PRINT YOUR FULL NAME HERE:   ____________________________________________________________________

Date of this Petition:            _________________           Your Signature:   ______________________________

This candidate recommended and vouched for on the honor of:

Noble  __________________________________ Shrine # ___________ Club/Unit ___________________

Noble  __________________________________ Shrine # ___________ Club/Unit ___________________

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(Attach to the petition a check or money order for $200.00.  This payment includes current year’s dues, your Oasis Fez and lapel pin.)  

FOR CREDIT CARD PAYMENT:    Card Type: _________________________________ (MC, VISA, DISCOVER)  

CARD # ____________________________________________________ EXPIRATION DATE: ___________