BECOME A NOBLE

To the Illustrious Potentate, Officers and Nobility of Asiya Shriners, situated in the Oasis of San Mateo, Desert of California:

Full Name

First Name

Last Name

Lady's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

DOB

MM

DD

YYYY

Birthplace

Profession or Occupation:

Hat Size:

Are You a Veteran?

Branch of Service:

Were you a DeMolay?

Chapter & Location:

Have you previously applied for admission in any Temple of the Order?

When & Where:

Recommended & vouched for on the Honor of Asiya Nobles:

First Name

Last Name

First Name

Last Name

I, the undersigned, hereby declare that I am a Master Mason in good standing in 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 six months, as required by the Bylaws of the Imperial Council. I respectfully pray that I may be made a Noble of the Mystic Shrine, and become a member of Asiya Shriners.

Enter your Lodge and its location (address and state)

Date

MM

DD

YYYY

BECOME A NOBLE

BECOME A NOBLE BECOME A NOBLE

BECOME A NOBLE