Winston-Salem Petition For Membership (with payment)

Winston-Salem Petition for Membership

Ancient & Accepted Scottish Rite of Freemasonry, S.J., U.S.A.
To the Officers & Members of the

Valley of Winston-Salem in the Orient of North Carolina:

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
Add Your Photo
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.

Masonic Information
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 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.

Recommending Masons
In order for your petition to be considered complete, you must be recommended by TWO Valley members in good standing.
Recommending Valley Member 1*

First NameLast Name
Valley Member 1 Email*

Confirmation Email
Recommending Valley Member 2*

First NameLast Name
Valley Member 2 Email*

Confirmation Emailexample@example.com

Initiation Fee
The fee for initiation in the Valley of Winston-Salem is $375.00 and covers your first year's dues, your reunion materials, 14° ring, 32° patent, A Bridge To Light text book & your 32° cap & case.
Please Note: Your petition will not be considered complete until your check has been received. Please make your check in the amount of $375 payable to Winston-Salem Scottish Rite and mail to:

Winston-Salem Scottish Rite
4537 Country Club Road
Winston-Salem, North Carolina 27104

Credit Card Payment *

Valley of Winston-Salem, North Carolina Full Initiation Fee PaymentValley of WInston-Salem, North Carolina initiation Fee paid in full.

$375.00

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

Sign & Submit
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
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Winston-Salem Petition for Membership