Mid- Atlantic Association of Shrine Motor Corps
APPLICATION FOR MEMBERSHIP
( Please Type or Print Plainly )
We hereby make application for membership in the Mid-Atlantic Association of Shrine
Motor Corps and agree to abide by the Rules, Regulations and Bylaws of said
Organization.
NAME OF TEMPE: ____________________________________
NAME OF UNIT: ______________________________________
NUMBER OF MEMBERS ON ROSTER: __________________
Please list in alphabetical order the name of each member, their mailing
address, zip code
number, and e-mail address if any.
NAME AND RANK OF OFFICERS:
1.________________________________ 4. ________________________________
2. ________________________________5. ________________________________
3.________________________________ 6. ________________________________
Enclose Fee of Twelve Dollars ($12.00) per member listed, which will pay the
first years dues.
The dues for active and non-riding members are the same. Make
checks payable to;
MID-ATLANTIC ASSOCIATION OF SHRINE MOTOR CORPS, AND MAIL TO:
Dale Zimmerman
52 Racehorse Dr.
Jonestown, PA 17038
(H) (717) 865-0281
Upon Receipt of your check, a certificate for your unit will be mailed along with the
individual membership cards.
APPROVED BY:
Potentate: ______________________________ Temple: _____________________