Kazim Shriners
Roanoke, Virginia


Petitions that can be filled out and printed are located below

Instruction: Type in the gray area and print

(See the sample below)


Petition for Initiation

Petition for Restoration

Petition for Affiiation

Restoration Special
A Shriner that was dropped for non-payment of dues can be restored for $170.00.


Life Membership Fees (You may pay any one portion or combination)

Over 65 years old - Temple dues for life = 10 times temple dues (10 x $100.00) $1,000.00

Under 65 years old - Temple dues for life = 20 times temple dues (20 x $100.00) $2,000.00

PCM (Hospital assessment) for life = 30 times hospital assessments (30 x $5.00) $150.00

Per Capita for life = 30 times per capita assessment (30 x $30.oo) $900.00