Covington, KY 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

Valley of Covington in the Orient of Kentucky:

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
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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.
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

The fee for initiation in the Valley of Covington is $375.00 ($325.00 for those age 30 and younger) and covers your first year's dues, your reunion materials, 14th degree ring, a copy of Morals & Dogma, and a copy of A Bridge to Light.
Please Note: Your petition will not be considered complete until your check has been received. Please make your check in the amount of $*** payable to ADD NAME HERE and mail to:

REPLACE Scottish Rite
1234 REPLACE DRIVE
REPLACE, RE 12345

Payment Options (please select one)*

Valley of Covington Full Initiation Fee Payment

Valley of Covington initiation Fee paid in full.

$375.00

Valley of Covington Full Initiation Fee Payment/Age 30 and younger

Valley of Covington (Age 30 and younger) initiation Fee paid in full

$325.00 Quantity

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
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Petition for Membership