Des Moines, Iowa Petition For Membership (with payment)

Petition for Membership

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

Valley of Des Moines in the Orient of Iowa:

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 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.

Recommending Masons & Valley Secretary
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 Des Moines, Iowa is $365.00 ($50 discount for candidates age 31 or younger) and covers your first year's dues, your reunion materials, 14° ring, full form conferral of all 29 AASR degrees, class picture, 2 gala tickets, and 32° patent.
How would you prefer to pay your initiation fee?

Credit Card (preferred)Check
Please Note: Your petition will not be considered complete until your check has been received. Please make your check in the amount of $365 ($50 discount for candidates age 31 or younger) payable to Des Moines Consistory and mail to:

Des Moines Scottish Rite
519 Park Street
Des Moines, IA 50309

Payment Options

Valley of Des Moines, Iowa Full Initiation Fee PaymentValley of Des Moines, Iowa initiation Fee paid in full.

$365.00

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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Please verify that you are human*
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Petition for Membership