Membership Application

MEMBERSHIP APPLICATION FOR THE
Ancient and Accepted Scottish Rite of Freemasonry
SOUTHERN JURISDICTION OF THE UNITED STATES OF AMERICA
ORIENT OF OKLAHOMA - VALLEY OF GUTHRIE

I respectfully petition to receive degrees from the 4th to the 32nd, inclusive

The following information is given upon my Masonic Honor:

*Today's Date

First Name*

Enter your name

Middle Name

in full

Last Name*

no initials please

Birthdate*

Street Address*

City*

State*

Zip Code*

County

Place of Birth*

Home Phone

Work Phone

Cell Phone

eMail*

Wife's Name

Occupation

If retired, please indicate what from

Employed By

MASONIC INFORMATION

Applicant must be a Master Mason in good standing in a Blue Lodge:

Name of Blue Lodge*

Lodge Number*

Situated in

City where lodge is located

Grand Lodge Jurisdiction

State or other Jurisdiction

Date Raised a Master Mason*

Date of Proficiency*

Have you previously applied for the Scottish Rite Degrees?yesno

If so, when?

Membership Application