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EGYPT SHRINE TEMPLE MEMBERSHIP APPLICATION DATE: _________________________ NAME: __________________________________ WIFE'S NAME: ______________________________ ADDRESS: ____________________________ZIP: _________________ HOME PH: _______________________ EMPLOYER: ______________________________________ BUS. PH: ________________________ ADDRESS: ________________________________CITY: ____________________________ZIP: ______________________ OCCUPATION: _________________________________________ BIRTHDAY: ______________________ PLACE OF BIRTH: ______________________________________ WIFE'S BIRTH DAY & MONTH: ___________________ WEDDING ANNIVERSARY DAY & MONTH: __________________________ SHIRT SIZE: ______________________ YEAR & PLACE YOU BECAME A SHRINER: ______________________________________________________________ I crossed the Hot Sands on: ___________________at: Temple: _________________________________________________ I understand that if I miss three consecutive meetings or drop below 70% attendance for any calendar quarter, that I may be suspended from membership: I will be able to attend: ALL _______PART _______ NONE __________of the out of town Ceremonials. I agree to pay the $100 initiation fee and annual dues of $75: _____________ 11 understand that all members must refrain from drinking alcohol before and during the Ceremonial on Ceremonial days: _____________ Recommended by: ___________________________ Seconded by : ______________________________
_______________________________________________ Assigned for Investigation: ___________________________________________ ___________________________________________ Date Assigned: __________________________ Date Investigated: ___________________ Date Notified: ___________________________ Date Inducted: _____________________
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Revised 05/28/02