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

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