Online Petition Info Form

Online Petition Info Form
In order to properly create a custom online form for your Valley, please fill out the information below. THIS FORM SHOULD ONLY BE FILLED OUT BY A VALLEY SECRETARY OR PERSONAL REPRESENTATIVE.
Orient & Valley

OrientValley
Your Name

First NameLast Name
SR Rank
Your Email
example@example.com
Your Valley Role
Does your Valley have its own website?

YesNo
Please paste your Valley's Web address here:
Does your Valley have a preferred logo to use for the header of the petition?

YesNo
Please upload your Valley logo here

Cancelof
Petitions will be delivered to the Valley via email, with inline text & a PDF of the petition. Please list the email addresses to which the petitions should be delivered (up to 5).
For example, the Secretary email, the office email, the PR email and so on.
Valley Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your Valley's initiation fee?
In addition to the degrees & Scottish Rite Patent, what is included in your initiation fee? (check all that apply)

14 degree ring32 degree capMorals & DogmaMaster Craftsman programOther
Do you want your petitioners to have the option of splitting the initiation fee into 2 or 3 payments?

YesNo
How should checks be made payable?
Please list any petition characteristics that may be unique to your Orient, Valley or Grand Jurisdiction.
Should be Empty: