The York Rite Research Institute
(PHA)

APPLICATION FORM

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NAME
ADDRESS

REGULAR MEMBER COST $12.00 US PER YEAR [ ]
SPECIAL MEMBER COST $12.00 US PER YEAR [ ]

CHARTER MEMBERSHIP $50.00 US [ MEMBERSHIP UNTIL 2000

PLEASE MAKE CHECKS PAYABLE TO:

THE YORK RITE RESEARCH INSTITUTE
WILLIAM D. MOORE
602 PERSHING STREET
LaFAYETTE, LA. 70501-519 USA