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Membership Application
Daniel Boone Shrine Club |
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Print this form by clicking on your printer icon, and
then follow instructions on bottom of page.
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| Noble's name:
_____________________________________________________________ |
| Lady's name:
______________________________________________________________ |
| Street address:
____________________________________________________________ |
| City ______________________________ State
__________ Zip Code _____________ |
| Noble's home
phone: _______________________________________________________ |
| Noble's work
phone:________________________________________________________ |
| Noble's cell phone:
_________________________________________________________ |
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E-mail: __________________________________________________________________ |
| Noble's birthday month/day: ________________
Lady's birthday month/day:____________ |
| Anniversary
month/day/year: _________________________________________________ |
| I am a member in good standing of Lodge:
________________________ Number: _______ |
| Lodge location:
___________________________________________________________ |
| I am a member in good standing of
__________________________ Shrine Temple
located in |
| City and State:
____________________________________________________________ |
| Signature of Applicant
_________________________________ Date _______________ |
| Print Name of DBSC Sponsor:
_______________________________________________ |
| Signature of DBSC Sponsor:
________________________________________________ |
| Application fee is $5.00 plus $15.00 which includes
your dues through December 31st. |
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INSTRUCTIONS: Print this page, complete all sections,
and mail the completed form with your check, to the address below.
Mail and make check payable to:
Daniel Boone Shrine Club
PO Box 476
St. Peters, MO 63376-0008 |
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