Mecca Shriners Petition for Initiation and Membership

Membership Interest Form

To The Potentate, Oﬃcers and Nobles of MECCA SHRINERS, situated in the Oasis of New York City, Desert of New York:

I, the undersigned, hereby declare that I am a Master Mason in good standing in the Lodge listed below, 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 6 months, as required by the bylaws of Shriners International. I hereby express my interest to become a Noble of the Order, and a member of your temple.

If granted membership, I promise to conform to the articles of incorporation and bylaws of Shriners International and the bylaws and ceremonies of your temple.

First Name

Last Name

Preferred Phone Number:

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Birthday

Company

Position

Retired?

Yes

I am:

not a Mason

a Mason (Entered Apprentice / Fellow Craft)

a Master Mason

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