Petition for Initiation and Membership EL KATIF SHRINERS
7217 W. Westbow Blvd., Spokane, WA 99224 Phone (509) 624-2762 (800) 369-2762 Fax (509) 624-8333
To the Illustrious Potentate, Officers, and Nobles of El Katif Temple situated in the Oasis of Spokane, Desert of Washington, I, ______________________________________________________________________________ First Name
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Last Name
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 granted, I promise to conform to the Articles of Incorporation and Bylaws of the Imperial Council and the Bylaws and Ceremonies of your Temple. Home Address: ________________________________________ City: ________________________________ Zip: ___________________ Home Phone: ____________________ Mobile Phone: ______________________ Birth Date: _____________________________________ Birthplace: __________________________________ Company Name and Position: _________________________________________________________________ Company Address, City, State & Zip: ____________________________________________________________ Work Phone: ___________________________ Email: ______________________________________________ Spouses Name: _____________________________________ Today’s Date: ____________________________ Candidate Signature: ________________________________________________________________________ Recommended and Vouched for on the Honor of Noble 1st Noble: _________________________________________________________________________________ Print Name
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2nd Noble: ________________________________________________________________________________ Print Name
Initiation Fee . . . . . . . . . $ 50.00 Dues . . . . . . . . . . . . . . . . $ 115.00 Fez . . . . . . . . . . . . . . . . . .$ NC Total $165.00
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Member #: ___________________ Hat Size: __________________ Elected: ___________________ Created: _____________________ Paid: ______________________ Date: _______________________