Utah Petition For Membership (with payment)

Petition for Membership

Ancient & Accepted Scottish Rite of Freemasonry, S.J., U.S.A.
This online petition is intended for new membership ONLY in the Southern Jurisdiction. If you are looking to affiliate with a Valley in the Southern Jurisdiction, please email membership@srite.org
To the Officers & Members of the Salt Lake Valley in the Orient of Utah:

I am a Master Mason in good standing, and respectfully petition to receive the Fourth through Thirty-second degrees, promising to bear true faith and allegiance to The Supreme Council of the Thirty-third Degree for the Southern Jurisdiction of the United States of America.
Full Name*

First NameMiddle NameLast NameSuffix
Preferred Name
Please click the arrows on the right and complete each section of the petition accurately and completely. To save and continue the form later, click the SAVE button at the bottom of the page. Once your petition is completed and submitted, it will be automatically sent to the Valley Secretary for further action.

Residence Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Is this your preferred mailing address?*

YesNo
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Preferred Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
What type of number is this?*

HomeCellWork
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What type of number is this?

HomeCellWork
Primary Email Address*

Confirmation Emailexample@example.com
Secondary Email Address

Confirmation Emailexample@example.com

Blue Lodge Information*

Lodge Name

Blue Lodge Number

City or TownState

Zip CodeCountry
I was raised to the Sublime Degree of Master Mason in the year:*
Have you passed your Master Mason's Catechism as required by your Grand Lodge*

YesNo
Have you previously petitioned this or any other Scottish Rite body?*

YesNo
Please explain which body you petitioned and why you were not made a Scottish Rite Mason.

In order for your petition to be considered complete, you must be recommended by TWO Valley members in good standing in the Valley of Salt Lake. List their names and emails below, and they will be notified automatically for confirmation.
Recommending Valley Member 1

First NameLast Name
Valley Member 1 Email

Confirmation Emailexample@example.com
Recommending Valley Member 2

First nameLast Name
Valley Member 2 Email

Confirmation Emailexample@example.com

The fee for initiation in the Salt Lake Valley is $500.00 and covers your first year's dues, your reunion materials & Scottish Rite Patent, 14° ring, 32° Scottish Rite cap, and the text books "A Bridge to Light" & "Morals & Dogma".
Please Note: Your petition will not be considered complete until your check has been received. Please make your check in the amount of $400 payable to Scottish Rite Valley of Salt Lake and mail to:

Scottish Rite Valley of Salt Lake

650 E S Temple

Salt Lake City, UT 84102

Credit Card Payment*

Salt Lake Valley Full Intitiation Fee Payment

Salt Lake Valley initiation Fee paid in full.

$500.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

I accept the following fundamental principles as required by the Supreme Council of the Ancient & Accepted Scottish Rite, Southern Jurisdiction for the United States of America.

On my honor as a Master Mason, I attest the information on this petition is complete and accurate and that this petition is being made of my own free will and accord and without any hidden motives or agendas.
Do you wholeheartedly approve of the inculcation of patriotism, respect for law and order, undying loyalty to the principles of civic and religious liberty, separation of church and state and protection of and respect for all individual rights as set forth in the Constitution of the United States of America?*

YesNo
Signature*

Clear
Use your mouse to sign, or if you have a touch screen you can use your finger or stylus.
Please verify that you are human*
Should be Empty:

Petition for Membership