PAST MASTERS UNIT
OF
Medinah Temple
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:________________________________________________________


Medinah
Medinah
Home Page