PETITION FOR INITIATION AND
MEMBERSHIP
PHILAE SHRINERS
Ancient Arabic Order Nobles of the Mystic Shrine
P.O. Box 9050, Station "A", Halifax, Nova
Scotia, Canada B3K 5M7
Telephone:(902) 454-7811 Fax:(902) 455-8963 E-mail: philaeshriners@hfx.eastlink.ca
www.NS-PEI-Shriners.com
To the Illustrious Potentate, Officers and
Members of Philae Temple, situated in the Oasis of Halifax.
I am a MASTER
MASON in good standing in
___________________________________________________,
Lodge No._________ A.F. & A.M.,
City___________________________________Prov._________________
and have been since
_________/_______/__________.
MM
DD YYYY
Furthermore, I do not now, and never will, hold
membership in or allegiance to, any Body claiming to be Masonic that has been
declared clandestine. I have resided
within the jurisdiction of your Temple, or in unoccupied territory, not less
than six months, as required by the constitution of the Imperial Council, and
that I am not under suspension or expulsion in Bodies prerequisite to this
Order, and 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 all the
Ceremonies, Engagements, Constitutions, Regulations and Edicts of the Imperial
Council together with those of your Temple.
Have you previously applied for admission to
any Temple of the Order?_______________________________.
If So, to what
Temple?______________________________________________________________________.
When?___________________________________________________________________________________.
Signature_________________________________________________________________________________.
(NAME
IN FULL - INITIALS NOT SUFFICIENT)
Date:_____________________________________________________________20______________________
THIS PETITION MUST BE SIGNED BY TWO (2) NOBLES IN GOOD
STANDING IN PHILAE TEMPLE
First Line Signer
PHILAE NOBLE___________________________________________Membership
#_____________________
PRINT Name
Here__________________________________________________________________________
Address:__________________________________________________________________________________
City:________________________________Prov:_________________Postal
Code:______________________
Telephone:
( )
________________________
Member of Shrine Club or
Unit:________________________________________________________________
Second Line Signer
PHILAE
NOBLE___________________________________________Membership
#_____________________
Print Full
Name:____________________________________________________________________________
(As desired for Mailing)
Lady's Name:______________________________________________________________________________
Residence:_________________________________________________________________________________
(Street)
City:_________________________________________Postal
Code:__________________________________
Home Phone
#:_________________________________Fax:_________________________________________
Birthplace:
City:_________________________________________________Prov.:______________________
Date of Birth:
Month:__________________________Day:________________________Year:_____________
e-mail
address:______________________________________________________________________________
Occupation:_________________________________________________________________________________
(Detail Please)
Business Address:___________________________________________________________________________
(Street)
City:___________________________________________Postal
Code:________________________________
Business
Phone:__________________________________Fax:_______________________________________
SEND SHRINE MAIL TO: Residence_______________________or
Business__________________________
Where you ever a DeMolay?________, if so, what
Chapter name and location___________________________
Hat Size__________________________ AMT. OF
CHEQUE ENCLOSED$____________________________
Temple units and committees and every Shrine
Club need men who are willing and able to help make Shrine activities as
enjoyable as they ought to be. You can
help, and if you do, your Shrine membership will have real meaning for
you. If you are interested in any of
the following, please check the appropriate box.