 
Petition For Membership
in the
Rajah Anglers Club
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I The undersigned, am desirous of being admitted as a member of the Rajah Shrine Anglers Club. I understand the duties of the Rajah Shrine Anglers club consists of providing service, assistance and support to the Rajah Shrine, the Illustrious Potentate and the elected officers of the Rajah Anglers. I will also encourage and support membership in shrinedom.
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The Rajah Anglers meets the 1st Wednesday of each month, attendance is not a requirement for membership.
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| Members will pay an initiation fee of $10.00 and yearly dues of $10.00 prorated at
1/12 per month. The dues run from July 1st of each year. |
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| Name: ___________________________________________________________ |
| Mailing Address: ___________________________________________________ |
| City:
____________________________ State: ______ Zip Code:
___________ |
| Occupation: _______________________________________________________ |
| Telephone: ______________________ E-Mail: ___________________________ |
| Age: _________ Lady's Name: _______________________________________ |
| Blue Lodge: ______________________ Shrine No. : _______________________ |
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Signature: ________________________________________________________
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Please print this form out, fill in the needed information and mail it to: Rajah Anglers, P.O. Box 40, Blandon, Pa. 19510,
or bring it to a meeting.
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| Recommended By Noble: ________________________ Shrine No: ___________ |
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Date of Ballot: ________________________
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