Presented in 4 copies to the Director of Parade Units who will sign copies and send them to
the Potentate, Parade Marshal and Parade Units.

PRINT or TYPE

From Unit or Shrine Club: ______________________________________________________________

Permission is requested to participate in:
Type of Function:                          Place                    Date                                     Time

The Unit members (have) (have not) indicated their willingness to participate.

This appearance is to be made without cost to Medinah Temple.

Submitted by: Appearance (is) (is not) approved:

____________________________ Signature ___________________________________ Potentate

Title: _______________________________ Date: ________________________________

Date: _______________________________ _______________________ Director of Parade Units