Ancient and Accepted Scottish Rite of Freemasonry
Southern Jurisdiction of the United States
Valley of Jacksonville, Orient of Florida
965 Hubbard Street,
Jacksonville, Florida 32066
Phone: (904) 355-7633
Fax: (904) 355-7443
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PLEASE PROVIDE THE FOLLOWING INFORMATION
Check One: Spring Reunion Fall Reunion
Date:
Enter your full name (no initials please)
First Name:
Middle Name:
Last Name:
Address:
City:
State: Zip:
Home Phone:
Work Phone:
Cell Phone:
E-mail:
Occupation:
Date of Birth:
Place of Birth:
I certify that I am a Master Mason in Good Standing in:
Lodge: Number:
Under the Grand Lodge of:
Date Raised to Master Mason:
Date of Proficiency ( If Master Mason less than 6 months )
If you have previously applied for these Degrees, state fully, date, place and to whom application was made:
Are you a Past Master? Yes No
If so, where? When?
Are you a Past District Deputy Grand Master? Yes No
If so, which District?
If you are married, wife's name: Anniversary:
If different from above
Mailing Address:
State:
Zip:
1. The Supreme Council requires the acceptance of the following fundamental principles: 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 as set forth in the Constitution of the United States of America. Do you wholeheartedly approve of these principles?
Yes No
2. Have you ever held or expressed opinions contrary to the foregoing or have been affiliated with any organization which has? If your answer to this question is Yes, give particulars.
Wholeheartedly believing in the foregoing, I respectively petition the Jacksonville Scottish Rite Bodies to receive the 4th. thru 32nd. Degrees; and by submitting this form agree to all of the above principles.
(insert the name of a Brother that you desire to be your Top Line Signer)
Recommended by:
(Member of Jacksonville Scottish Rite Bodies)
Jacksonville Scottish Rite Initiation fee is $230.00; this includes $175.00 initiation fee plus yearly dues of $55.00, for all Degrees. A $100.00 deposit is required up front.
I will send you a check.
I will send you a money order.
Make check or money order payable to:
Jacksonville Scottish Rite Bodies
Send to the above at:
965 Hubbard Street
Jacksonville, Florida 32206
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Ill. Jack M. Newport, 33°, Webmaster@aasrvalleyofjax.org
Ill. David A. Yarborough, 33°, General Secretary
Jacksonville Scottish Rite Masonic Center
Phone: (904)355-7633
Fax: (904)355-7443
Scottish Rite Office Hours-Monday-Friday-8:00 AM-4:00 PM
This Website was last updated on March 19, 2008