application

Desert of Illinois A.A.O.N.M.S. Oasis of Chicago

550 North Shriners Drive Addison, Il. 60101

I hereby make application for membership in the Past Masters Unit of Medinah Temple A.A.O.N.M.S.

Oasis of Chicago, Illinois.

I certify on my honor as a Master Mason and Noble that:

I am a Master Mason in good standing of_________________________________________________

Lodge & Number

Located at__________________________________________________________________________

Address City State Zipcode

And that I have served as Worshipful Master during the year of______________________________

Are you a member of a Unit, Committee or Shrine Club of Medinah Temple? (Y) (N)

If you answer is yes, please list them_____________________________________________________

____________________________________________________________________________________

Name:_____________________________________________________________________________

First Middle Last

Address___________________________________________________________________________

City State Zipcode

Telephone # Home:_____________________ Business:__________________ Cell:_____________

Wife's Name:________________________________ Wife's Birthday:__________________________

Wedding Anniversary:________________________ Your Birthday:____________________________

Medinah Membership #:______________________ your Fez size:________________

Signature________________________________________ Date:_________________

Email:________________________________________________________