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

This petition may now be printed from the following pdf file.

Petition for Reinstatement pdf.file

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Please provide the following information:

T o the Officers and Members of the Jacksonville Scottish Rite Bodies, Valley of Jacksonville, Orient of Florida, I, whose name appears below, respectively petition for the reinstatement of my membership to these Bodies.

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:             

Date of Birth: 

Place - City:   

State:              

If married, wife's Name: Anniversary:

I was formerly a member of:  Jacksonville Scottish Rite Bodies;    Other.

If Other, Valley of: Orient of:  When?

Symbolic Lodge Information:

I am now a member, in Good Standing, of Lodge No.

Located at:   

City:          

State:        

Date Raised to the Sublime Degree of Master Mason:

Are you a Past Master?  Yes    No

If so, Lodge: No.: When?

Give in detail; if retired, state former occupation:

Profession or Occupation:

                          Employer:   

             Employer's Phone:

Upon receipt of this Petition for Reinstatement accompanied by a check or money order in the amount of $110.00 payable to The Jacksonville Scottish Rite Bodies, you will be contacted by the General Secretary.

Send Check or Money Order to:

Jacksonville Scottish Rite Bodies

965 Hubbard Street

Jacksonville, Florida 32206