To the Potentate, Officers, and Nobles of BOUMI SHRINERS, situated in the Oasis of Baltimore, Desert of Maryland:
I, the undersigned, hereby declare that I am a Master Mason in good standing in the following Lodge, which is a Lodge recognized by or in amity with the Conference of Grand Masters of North America. Furthermore, I have resided at my current address for not less than 6 months, as required by the Bylaws of Shriners International. I hereby make application to become a Noble of the Order, and a member of your temple.
If granted membership, I promise to conform to the Articles of Incorporation and Bylaws of Shriners International and the Bylaws and ceremonies of your temple.
Recommended and Vouched for on the Honor of: (Both must be members in good standing of Boumi Shrine)