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Committee Chairman
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 be 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 _____________________________________
Noble _____________________________________