EGYPT SHRINE TEMPLE

Oriental Band Membership Application

Noble ____________________ Wife ______________________

Address______________________________________________

City _______________________ State ______ Zip ___________

Birth Date _______________Occupation___________________

Residence Phone _________ Business Phone ________________

Temple Membership Number_____________________________

Instructions: "O" Own Regalia "L" Loaned Regalia

Red Blazer _____  Yellow Shirt ______ Yellow Jacket ______

Black Pants _____ Fez Strip ______ Parade Uniform _______

I, the undersigned, am an Egypt Shrine Temple noble, am not a member any unit, nor a Shrine Club officer. I will abide by all Unit by-laws, will participate to the best of my ability in all meetings and rehearsals, and whenever called upon to appear, play or parade. I remit herewith this years dues, (1/2) Jan-June, (1/2) July-Dec., plus $25.00 initiation fee (refunded if not elected of if not certified).

I understand election is as "Trainee" and will not be an "Active Member" until certified by the Proficiency Board. Only then will I be entitled to voting privileges and pilgrimage benefits.

SIGNED________________________________   DATE ____________

SPONSOR ______________________________  DATE ____________

SPONSOR ______________ _______________    DATE ____________

Initiation Fee Paid $___________ Dues Paid $_______________

Revised: 04/04/04