Petition for Degrees

Valley of Dothan Scottish Rite

PO Box 1074

Dothan, Al. 36302-1074

PLEASE PRINT

FIRST NAME_____________________________MIDDLE NAME______________________LAST NAME_______________________

ADDRESS____________________________________LADY'S FIRST NAME_______________________________________________

CITY_______________________________STATE__________________ZIP_______________________________________________

DATE OF BIRTH___________________IN (OR NEAR) CITY/STATE______________________________________________________

LODGE NAME AND NUMBER_____________________________________CITY/STATE____________________________________

OCCUPATION________________________________COMPANY_______________________________________________________

(IF RETIRED WHAT DID YOU DO?)

HOME PHONE______________________________WORK PHONE________________________CELL PHONE____________________

E-MAIL ADDRESS______________________________________

HAVE YOU EVER PETITIONED FOR ANY OF THE SCOTTISH RITE DEGREES?______________

IF YES, WHERE, WHEN AND THE RESULTS_________________________________________________________________________

I believe in the inculcation of patriotism, respect for law and order, undying loyalty to the principles of civil and religious liberty, and the entire separation of church and state.

I am a master mason in good standing and respectfully petition to receive the 4th-32nd degrees.

LEGAL SIGNATURE______________________________________________________DATE_________________________________

RECOMMENDER AND AVOUCHER MUST BE MEMBERS OF THE VALLEY OF DOTHAN

RECOMMENDER________________________________AVOUCHER___________________________________________

(PRINT NAME)_________________________________                        ___________________________________________

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FEES: $150.00                                                          |                                                 (Office use)

ANNUAL DUES: $60.00                                            |                                                 FEES PAID:_________________________

PAYABLE TO : THE LODGE OF PERFECTION         |                                                 RECEIPT#__________________________CHECK #___________________________

INCLUDES: 4th-32nd Degrees, 14 Degree Ring              |                                                 PRESENTED_______________________ELECTED:___________________________

in Pyramid, Patent                                                     |                                                 NOTIFIED:__________________________                                        

Perpetual Membership $650.00                                    |                                                  RING SIZE__________________________HAT SIZE__________________________