Text Box: Yankton Scottish Rite News
Text Box:             Sept.  2012	     Page 5

First Name: ________________________________ 
Middle Name: ______________________________
Last Name: ________________________________
Mailing Address: ____________________________
Street or Ave.: ______________________________
Rural Route Box No.: ________________________
City :______________________________________ State: _____________________________________ 
Zip Code: __________________________________
Date of Birth: __________________(month/day/year) Place of Birth: _______________________________
(Give detailed information about occupation, if merchant, what kind of merchant, what kind of engineer, salesman, plumber, manager, etc.)
Telephone:  Home:__________________________
	     Work:  __________________________
                    Cell: ____________________________

Email:  ____________________________________

Occupation: ________________________________ 

Spouses Name:______________________________

If retired, occupation before retiring:____________________________________________________________________________________

Employer (note if self employed):__________________________________________

Blue-Lodge Name: __________________________
No.: ________ 
City: ________________________________
State: ________________________________
Text Box:      I am a Master Mason in good standing, eligible to petition for the Scottish Rite Degrees, (if a member of a South Dakota Lodge, I have proved up on the Master Mason Degree) reside as shown below and am a qualified voter of such state.  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 the 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 principles of civil and religious liberty and the entire separation of church and state as set forth in the constitution of the United States.*

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 that has?_____
If you answer in the affirmative, give particulars:___________________________________________________________________________________________________________________________
Recommended by:    
Usual Signature of Petitioner:_________________________________
Text Box: FEES: For the degrees from 4th to 32nd, $175. If under age of 31 at the date of initiation $100. A deposit of $50 must accompany petition. Flexible payment plans are available for the balance.  We also accept VISA,  MasterCard or Discover payment in person or by phone.  Please complete this petition and mail check and Petition to: Yankton Scottish Rite, PO Box 124, Yankton, SD 57078, Lodge phone number 665-2414   Any Master Mason may apply for the degrees for the Scottish Rite provided he is in good standing, has proved up to the Master Mason degree, and is recommended by two Members of the Rite.  
Text Box: Payment Options & Amount Paid:
Cash            $_________________
Check          $_________________               
Visa             $_________________		
MasterCard $_________________
Discover      $_________________                                                           	
Card Number:______-_______-______-______      

Exp. Date: _________

Last 3 Digits on Back of Card:  _________  

Signature:______________________________Text Box:   
Date Received:    ___________________

 Date Elected: