Page 6 - JHC 11 Membership Bio
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I am requesting to reinstate in Chapter No.
Reason dropped from Chapter rolls
Recommended by Companions: 1._________________ /2.
__________________/3.___________________
I affirm that all questions have been answered correctly and truthfully by me.
Petitioner’s Signature: Date:
Investigation Committee’s Action
We, recommend: Favorable Unfavorable
Special Membership (Over the age of 55): Yes No
Investigation Committee: _______________ _____________________
______________________
Chairman Member Member
(Please attach copy of Investigation Committee Report)
Date Exalted_______________________________ Date Reinstated:_____________________
Secretary Signature:_______________________
Most Excellent High Priest’s Signature: ___________________
Most Excellent Prince Hall Grand Chapters Fees Accompanying Petition: (Please Circle One)
$20.00 ~ New Members (Diploma included)
$20.00 ~ Reinstatement
Local Chapter Fees Accompanying Petition: $__________________________
Total Fees Accompanying Petition: $_________________________
