HIGHLANDS SHRINE CLUB MEMBERSHIP APPLICATION

I,______________________________________ DATE____________

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Mailing Address,__________________________ City,_________________State,____

Hereby make application for membership in HIGHLANDS SHRINE CLUB and will cheerfully conform to all the By-Laws and Regulations of this club; and also knowing this Club will be governed by the POTENTATE OF EGYPT TEMPLE.

I am a member in good standing of Lodge__________________________ No._________

And/or Commandery No. __________________Knights Templar,___________________

Consistory ______________________________ Temple card No. ___________________

Temple, ________________________________ State_____ Home Phone _____________

I do/do not wish to demit to Egypt Temple

I do/ do not wish to become an associate member of Egypt Temple.

Retired, ________ Hobby, ________________________ Wife’s Name, _________________

Sponsor________________________________________

Sponsor ______________________________________ Noble,__________________________

Signature of Applicant

Initiation Fee $25.00

Dues 20.00

Total 45.00 To accompany application

Additional Information _________________________________________________________

Do you hold dual membership with any other Temple? YES NO

If yes, please name Temple. _____________________________________________________

I want to serve on the following committees:

House ( ) Clowns ( ) Kitchen ( ) Parade ( ) Decorating ( )

Shrine Store ( ) Building/Grounds ( )