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__________________________________________________________________________
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:_____________________________
