Petition For Initiation and Membership

To the Potentate, Officers and Nobles of Al Menah Shrine Center, situated in the oasis of Nashville, Desert of Tennessee: I, the undersigned, hereby declare that I am a Master Mason in good standing in ________________________________ Lodge #__________, located at __________________________________, ________________, which is a 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 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.

If I am found worthy, and my request is granted, I promise to conform to the Articles of Incorporation and Bylaws of the Imperial Council and the Bylaws and Ceremonies of your temple.

Birthplace_________________________________ Date of Birth ___________________

Were you ever a DeMolay? ________________ If so, what was the Chapter name and Location? _______________________________________________________________

Profession or occupation ___________________________________________________

Have you previously applied for admission to any temple of the Order? ______________

If so, what Temple? ___________________________ When? _______________________

Residence Address__________________________________________________________

Business Address __________________________________________________________

Mailing Address ___________________________________________________________

Phone: (Home) ________________________ (Business) __________________________

E-Mail Address ____________________________________________________________

Wife’s Name ______________________________________________________________

Date ________________, 20____ Signature: ___________________________________

Print Full Name Here: ______________________________________________________

Name in Full, initials are not sufficient

Recommended and Vouched for on the Honor of: Noble _____________________________________

Phone Number: ____________________________ Print Name _____________________________________

Noble _____________________________________

Phone Number: ____________________________ Print Name _____________________________________