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PETITION
FOR AFFILIATION
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, a Noble of the Mystic Shrine, initiated in_______________
Shriners located at _______________________, 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 Shrine Chapter. I furthermore state that
I have not been suspended or expelled in my prerequisite to the Shrine, to
wit: my Masonic affiliation, since the date of issuing the Demit presented
herewith.
I
am a Master Mason in good standing in _____________________ Lodge No.
________ , located at ____________________________
Birthplace: ________________________ Date of
Birth:__________
Profession or
occupation:_____________________________________
My full name (please print)
:___________________________________
Residence
address:_________________________________________
(Street or RFD (No Post Office Box)
_______________________________
________ _______________
(City)
(State)
(Zip)
Mailing address (if different from
above):__________________________
(Street
or P.O. Box) (City, State & Zip)
Phone:
Work: ( ____ ) _____ _________ Residence:
( ____ ) _____________
E-mail
address, if any:________________________________
Date of This Petition: _________________ 20
_____
Signature: __________________________________
(Your FULL Name)
Recommended by:
Noble ___________________________ Shrine No.
______________
Noble ___________________________ Shrine No.
______________
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