To the COMMITTEE ON ELECTIONS: 



We have the honor to propose as resident 



member of the Club, 



Name in full 



Occupation 



Residence 



Address , 



Proposer. 

 Seconder. 



Boston, 190 . 



For the assistance of the Committee, proposers are requested to add the names and 

 addresses of gentlemen, rurt necessarily members of the Club, who are acquainted with 

 the candidate. 



NAMES. 



ADDRESSES. 



MEMORANDUM CONCERNING 

 CANDIDATE. 



