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FT. LAUDERDALE SHRINE CLUB
of MAHI SHRINERS
APPLICATION
NOBLES NAME : _________________________ BIRTH DATE : ______________
_________________________________________________________________
ADDRESS:_________________________________________________________
Street City State Zip Code
PHONE ( ) _______________Home ( ) ______________Cell ( ) _____________
E-MAIL: _____________________________ (important)
PRESENT OCCUPATION (optional): ____________________________________
LADY’S NAME : ___________________________
Activities of interest: Clowns____, Dune Buggies____, Tin Lizzies____, Band_____,
Honor Guard____, Antique cars____, Other____________________.
Do you agree to try and attend all stated meetings of the MAHI SHRINE?__________________
Do you agree to attend FT. LAUDERDALE SHRINE CLUB Meetings when scheduled? ______
Annual Dues $25.00. Please make your check payable to: FT. LAUDERDALE SHRINE CLUB.
I _______________________________by signing hereby affixed, do hereby agree to uphold the
by-laws of MAHI TEMPLE and FT. LAUDERDALE SHRINE CLUB. I also agree to carry out the
orders of the Board of Governors in keeping with the guidelines of the MAHI TEMPLE Potentate
and the Divan. I will not participate in any organization or group that sanctions beliefs that oppose
or contradict the MAHI TEMPLE this SHRINE CLUB or the MASONIC ORDER.
Signed : ______________________
MAIL TO : Ron Anania Date : ____________________
10910 SW 10th Court
Davie, FL 33324
Approved : ____________________ President
Recorded : ____________________ Secretary
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