To the Officers and Members of the Scottish Rite Bodies sitting in the Valley of Detroit:

I, the undersigned hereof, respectfully show that I am desirous of being admitted as a member in the Valley of Detroit and request that I may be received among you, and that I will ever pray for the prosperity and glory of the Fraternity and the welfare of the Brethren.

First Name* Middle Initial

Last Name*

Date of Birth* (MM/DD/YYYY)

City of Birth* State of Birth*

Name of Spouse (if applicable)

Mailing Address:

Street Address*

City* State* ZIP

Primary Phone* Secondary Phone

Business Address:

Employer Occupation

Street Address*

City* State* ZIP

Business Phone*

I am a Master Mason in good standing in #

located in .

Have you ever before petitioned for any Degrees in the Scottish Rite and been accepted or declined?  Yes No

If Yes, to which Valley and when?
Lodge Name Date

Recommendations by two Valley Members:

Name 1 Member # on dues card

Name 2 Member # on dues card

Your Email Address*