Your Full Name:
_______________________________________________________________
Address:
____________________________________________________________________
_
City, State, Zip:
________________________________________________________________

Date of Birth:___/___/___

Place of Birth: __________________________________________



Occupation:
___________________________________________________________________
Employer:
____________________________________________________________________


Home Phone: (_____) ___________________ Business Phone: (_____)
____________


Blue Lodge Name:______________________________________________ No.
______

Date Raised: ___________________________

Your Lady’s Name: _____________________

I have resided in California for _____ years.

I have never applied for any of the Scottish Rite Degrees and I now respectfully
petition to
receive the Degrees from the 4th to the 32nd inclusive, promising always to bear true
faith
and allegiance to the Supreme Council of the Thirty-third Degree, for the Southern
Jurisdiction of the United States.

1. The Supreme Council announces as fundamental principles the following:
“The inculcation of patriotism, respect for law and order and undying loyalty
to the constitution of the United States of America.”
“The entire separation of church and state and opposition to every attempt
to appropriate public monies—Federal, State and local—directly or indirectly,
for the support of sectarian or private institutions.”

Do you approve wholeheartedly of these principles?
_________________________________

2. Have you ever held or expressed opinions contrary to the foregoing or been
affiliated
with any organization which has? If you answer this question in the affirmative, give
particulars on a separate sheet of paper.
_________________________________________________

Recommended By:

___________________________________

____________________________________


Petitioner’s Usual Signature:___________________________________

Dated: _________________________ , 20___


Class (Degrees 4°–32° inclusive): $200, plus $95 for 2008 Dues.
Total Fees & Dues: $295. ($195 for applicants under 31.)

Send check or money order for $200.00 to  Sacramento Scottish Rite,
6151 H Street, Sacramento, CA 95819.
Ancient and Accepted  Scottish Rite of Freemasonry
Southern Jurisdiction,
Orient of California,Valley of Sacramento,
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