BEN ALI SHRINERS
3262 MARYSVILLE BLVD., P.O. BOX 21-4477, SACRAMENTO, CA95821-4477
Office (916) 920-4107 Fax (916) 920-0690
PETITION FOR INITIATION AND MEMBERSHIP
To the Illustrious Potentate, Officers and Members of Ben Ali Shriners, Oasis of Sacramento:
I, the undersigned, hereby declare that I am a MASTER MASON in good standing in ______Lodge No. ______
and have been since (Date)______Address/City/State:______.______
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 six months, as required by the bylaws of Shriners International. I hereby make application to become a Noble of the order, and a member of your temple. I promise to conform to the Articles of Incorporation and Bylaws of Shriners International and the Bylaws and Ceremonies of your temple.
Have you previously applied for admission to any temple of the Order? ______Temple? ______When? ______
APPLICANT:
Print Full Name: ______Spouse Name: ______
Residence: ______City______Zip______
Phone(_____)______Fax______E-Mail______
Birthplace: City/State ______Date of Birth: Month ______Day ______Year______
Hat Size______Profession or Occupation:______
BusinessAddress/City/State/Zip______
Business Phone (______)______Fax ______Other______
SEND SHRINE MAIL TO: Residence______Business______Were you ever a DeMolay? ______
Are you a member of Scottish Rite_____ City and State ______York Rite______City and State ______
Did you serve in the military or currently serving? ______Branch of service: ______
SIGNATURE: ______Date: ______
Sign Name in Full
Involve yourself, Get Active. Join a Shrine Club, Unit or Committee. Please circle group(s) you would like to learn more about.
Activities (Refreshments)Band
Bedouins (RV)
CentralSacValley Club
Chico Club
Cibara Motor Corps (Go-Karts)
Circus
Classic Auto
Clowns
Escalon Club
Feather River Club
Gold Country Club
Golf Club
Hillbilly Clan
Intermountain/Modoc Club
Islanders
Keystone Cops
Lassen Club
Legion of Honor
Lions Head
Mark Twain Club
Montezuma Club
Mother Lode Club
Motor Escort
Motorcycle
Nor Cal Club
Novice
Paradise Club
Past Masters
Patrol (Marching)
Peace Officers
Pipes & Drums
Purveyors (Cooking)
Ritual
San Joaquin Club
Siskiyou Club
Sportsman Club
Tehama Club
Tokay Club
Tour Guides, Hospital
Tommyknockers
Transportation Drivers
Wrecking Crew
Yacht
Yolo Club
PETITION MUST BE SIGNED BY TWO NOBLES IN GOOD STANDING IN BEN ALI SHRINE
Top Line Signer, NOBLE: ______Member # ______Phone: ______
2nd Line Signer, NOBLE: ______Member # ______
FOR OFFICE USE RECORDER'S RECORD:
Elected ______Check $______Created ______Member No ______
Visa or Master Card No.______Expiration Date______Code on back_____
Call the Office for the amount of the Initiation Fee