Ballut Abyad Shrine Nomads

Albuquerque, New Mexico

Petition for Membership

Last Name:__________________________

First Name:__________________________ Wife :________________________ 

Street Address: ___________________________________________

City:_______________________________  State: _____ Zip: _________________

Residence Phone:(____) ____ -___________ Cell Phone: (______) _______-____________

E-Mail Address: ____________________________@________________

I am a Noble in good standing in_________________________________________ Shrine Temple.

I currently own an RV (Motorhome __, Travel Trailer__, 5^th Wheel __, Other _____________).

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__________________________________Signed_______________________________

Date ___/___/_____ .... (Petitioner) 

 

Printed ________________________________, Signed_______________________________

Date___/___/___.....(Sponsor)

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