Thank you for your interest in becoming a member of Scottish Rite. Please fill out the following form.  You may return the form in any one of the following ways:

  1. Fill out the online form below and press the "Submit" button at the end of the form. The completed petition will then be routed to the Scottish Rite Stockton Valley General Secretary in your area via E-mail;
    or,
  2. Print the form, fill it out and mail it to the General Secretary of that Scottish Rite Stockton Valley.
     

You will be contacted shortly after your application is received. Thank you!

 

Scottish Rite - Orient of California - Stockton Valley
Petition for Membership!

 
Date:
Enter your Full Name (Initials not sufficient)
First Name:
Middle Name:
Last Name:
Address:

9 Digits Required         

City: State:   Zip: 
Home Phone:   Fax:
Social Security Number:
E-mail:
                                     
Date of Birth:
City: State:
                            
Wife's Name: Anniversary:
 I have resided in California for:
Years: Months:
Blue Lodge Information:
Blue Lodge: Number:
Located At: State:
Years: Months:
Date Raised:
                     
Are you a 
Past Master?		 Yes    No 
If so, Where? When? 
Give in Detail.  If retired, state former occupation:
Profession or
Occupation:
Employer:
Employer Phone:
Hobbies or
Interests:
                               
Have you previously petitioned for any Scottish Rite Degree? Yes    No 
If so, Where? When? 
                          
I believe in the inculcation of patriotism, respect for law and order, and undying loyalty to the principals of civil and religious liberty, the entire separation of church and state as set forth in the Constitution of the United States of America.  Wholeheartedly believing in the forgoing, I respectively petition to receive the 4th thru the 32nd degrees.  (Please note:  By electronically submitting this Petition, you agree to the above.)
             
If different than above:
Mailing Address:

9 Digits Required       

City:   State:   Zip: 
                                 
Recommended By:   

1. Name
Telephone No.
                 (Member of Bodies)

2. Name
Telephone No.
                 (Member of Bodies)
                                                    
I certify that all information contained in this application is true and complete.

Signature
Date

Please Note: By sending this Application by E-mail, you are automatically certifying that the information contained in this application is true and complete.


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