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Kora Exit Interview
Step
1
of
2
50%
Your Name
(Required)
First
Last
Noble Being Contacted Name
(Required)
First
Last
Method of Contact
(Required)
Phone Call
In Person
Email
Other
Contact Attempt Number
(Required)
First Attempt
Second Attempt
Third Attempt
Other
Phone Numbering Being Called
(Required)
Location of Conversation
(Required)
Email Address Being Contacted
(Required)
Were you able to make contact with the noble?
(Required)
Yes, I was able to speak to the noble
No, I attempted but was unable to make contact.
Ask the following questions and enter the response you receive.
What were your reasons for joining the Shrine? Please check all that apply
(Required)
Family Tradition
To Make New Friends
To Attend Social Functions
The Prestige of Being a Shriner
To Help Children
To Increase My Networking
What were your reasons for joining the Shrine? (Additional Comments)
What were your reasons for allowing your Shrine membership to suspend?
(Required)
Simply Lost Interest
Just too busy
Too Much Lost Family Time
My Job is too Demanding
Financial Difficulties
Too Much Travel Time
Dues are too High
Moved from the Jurisdiction
Poor Health
The Shrine is Poorly Managed
Ceremonial Hazing
Arabian/Muslim Orientation
I Dropped My Blue Lodge Membership
I Became Disenchanted with a Person(s), Club, or Unit
What were your reasons for allowing your Shrine membership to suspend? (Additional Comments)
Please indicate their Number One Reason and includes any other reasons they mention.
While a Member, How Often Did You Attend Business (Stated) Meetings?
(Required)
Every Month
Every-other Month
Seldom
While a Member, How Often Did You Attend Business (Stated) Meetings? (Additional Comments)
How Often Did You Attend Social Functions?
(Required)
Often
Occasionally
Never
How Often Did You Attend Social Functions? (Additional Comments)
Did Your Lady Attend Social Functions?
(Required)
Yes
No
Did she enjoy them?
(Required)
Yes
No
Did Your Lady Attend a Social Function? (Additional Comments)
Were any of Your Reasons for Joining the Shrine Fulfilled?
(Required)
Yes
No
Were any of Your Reasons for Joining the Shrine Fulfilled? (Additional Comments)
Are You Still an Active Master Mason?
(Required)
Yes
No
Are You Still an Active Master Mason? (Additional Comments)
Would You Ever Consider Becoming an Active Member Again?
(Required)
Yes
No
Would You Ever Consider Becoming an Active Member Again? (Additional Comments)
Would it be okay for a Fellow Shriner to Personally Contact You?
(Required)
Yes
No
Would it be okay for a Fellow Shriner to Personally Contact You? (Additional Comments)
10326
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