Ballut Abyad Shrine Nomads

Albuquerque, New Mexico

Petition for Membership

Last Name:              First Name:               Wife’s Name: 

Street Address:

City:                                State:                             Zip:

Residence Phone:                                     Cell Phone:

E-Mail Address: _____________________@________________

I am a Noble in good standing in                                Shrine. I currently own a self-contained RV (Motorhome, Travel Trailer, 5^th Wheel, etc.). If accepted for membership in the Ballut Abyad Nomads I agree to abide by and uphold the General Regulations and By-Laws of Ballut Abyad Shrine as set forth for Shrine Clubs as well as the By-Laws of the Ballut Abyad Shrine Nomads.

             I have enclosed $15.00 initiation fee + $10.00 annual dues ~ total $25.00

 

 

Printed and Signed (Petitioner)                           Date

 

Printed and Signed (Member Sponsor)                 Date

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