Membership Survey Membership Survey Name * Lady's Name Address * City * State * Zip * Home Phone * Work Phone Email * Number of Children Children Age 0-10 Children Age 11-18 Children Age 19-25 Children Age 26-35 Children Age 36+ Survey Why did you join the Shrine? Make new friends Shriners Hospitals Family Tradition Other reasons for joining: What is Anah's public image? * ...ExcellentGoodFairPoor What should the Shrines priority be? * ...SocialHospitalsParadingClubs or Units Your favorite type of music: Are you interested in joining a club? * ...YesNoAlready a member Are you interested in joining a unit? * ...YesNoAlready a member Who introduced you to the Shrine? * Are you a member of the York or Scottish Rites? * ...NoYorkScottishBoth New reCAPTCHA