EGYPT TEMPLE

RAILROADERS

PO BOX 22805

TAMPA, FL 33622

PETITION FOR MEMBERSHIP

If I be found worthy, and my request granted, I promis to conform to all Ceremonies, Engagements, Constitutions, Regulations and Edicts of the RAILROADERS Unit of Egypt Temple

 

PRINT FULL NAME_______________________________________________________

BIRTHPLACE______________________ DATE OF BIRTH___________

ADDRESS__________________________________________________

CITY___________________________ STATE____ ZIP+4_____________

WIFE'S NAME____________________MONTH & DAY OF BIRTH_____

ANNIVERSARY_______________

HOME PHONE (______)_______

BUSINESS PHONE (_____)________

PROFESSION OR OCCUPATION________________________________________________

SIGNATURE________________________________ TEMPLE NO._____

RECOMMENDED AND VOUCHED FOR ON HE HONOR OF:

NOBLE______________________________________ TEMPLE NO.___

NOBLE______________________________________ TEMPLE NO.____

INITIATION FEE: $100.00

YEARLY DUES: $ 50.00

DATE RECEIVED _________________ AMOUNT $__________________

DATE ELECTED____________________________