Petition for Initiation and Membership

  • MM slash DD slash YYYY
  • If you do not know your size, please use this guide (jpg).
  • Financial Obligation Due: $165

    $165 (includes $100 initiation fee + $65 annual dues) is due to Kem Shriners at the time of initiation.
  • To the ILLUSTRIOUS POTENTATE, OFFICERS and MEMBERS of KEM SHRINERS, Oasis of Grand Forks, ND, I, the undersigned, hereby declare that I am a Master Mason in good standing of:
  • I furthermore represent that I have never applied for said order, nor has any other Shrine oasis rejected me, to the best of my knowledge. If I be found worthy and my request granted, I promise to conform to all the ceremonies, engagements, constitution, regulations and edicts of the Imperial Council together with those of Kem Shriners.
  • Please type your name in the box above as your signature.