Ancient Accepted Scottish Rite of Freemasonry

Northern Masonic Jurisdiction of The United States of America

Valley of Peoria, Illinois

400 NE Perry Ave

Peoria, IL    61603

309-676-4472

Application for New Membership, Dual Membership,  or Affiliation

I, the undersigned hereof respectfully show that I am desirous of being admitted as a member of the

Central City Lodge of Perfection (14°)                                Peoria Council, Princes of Jerusalem (16°)

Peoria Chapter of Rose Croix (18°)                                                                      Peoria Consistory (32°)

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. In making this application,  I hereby promise on my word of honor that should I be accepted and become a member of your honorable body,  I subscribe to the following:

                         “I, the undersigned, do hereby promise on my word of honor, and swear true faith, allegiance, s and fealty to the Supreme Council of Sovereign Grand Inspectors General of the 33rd and Last Degree of the Scottish Rite of Freemasonry for the Northern Masonic Jurisdiction of the United States of America,  sitting at its grand east in the town of Lexington, Massachusetts, and that I will support and abide by its constitution, orders and decrees “ 

                         “That I will hold allegiance to the said Supreme Council and be loyal thereto as the  supreme authority of the Rite; will hold illegal and spurious every other body that may be established within its Jurisdiction claiming to be a Supreme Council to which said Supreme Council has not extended due recognition as such; and every other body of said Rite within the same Jurisdiction that does not hold its powers from said Supreme Council or from a Supreme council recognized by it, and will hold no communication whatever in Scottish Rite Masonry with any member of the same, nor allow him to visit in any the Body of the Rite of which I may be a member; and I will dispense justice to my Brethren according to the laws of equity and honor.”

                         “And should I  violate this my solemn  vow and pledge, I consent to be expelled from Scottish Rite Masonry,  and all rights therein and in any Body of the Rite, and to be denounced to every Body on the of the Ancient Accepted Scottish Rite in the world as a traitor and forsworn.”

                         “And may God aid me to keep and perform the same. Amen.”

 

Signed, (your name in full): ________________________________________________________ Date: ________________

 

 

 

Fees for New Membership: $110.00 (Includes Dues) —$45 Due with Application..   Fee for Dual or Affiliation, $10.00

Recommended by (Valley of Peoria Members)

FIRST  Line Sponsor

SECOND Line Sponsor

NAME (PLEASE PRINT)

 

 

SIGNATURE

 

 

MEMBERSHIP NUMBER (Dues Card)

 

 

COMPLETE THE FOLLOWING REQUIRED INFORMATION

Name: First                                             Middle                                                          Last                 

Birthdate: Month               Day             Year                           Place of Birth

Preferred Mailing Name:                                                                                               Name of Spouse

Current Street Address                                                                                                 (Apt, Box, etc. )

City                                                                    State                                        Zip                       —-

Employer:                                                                      Profession                                                Years at Current Address

I am currently  a Master Mason in good standing in the following Blue Lodge:

Name                                                                Number                                               State or Country

I certify that I am not suspended from the Ancient Accepted Scottish Rite in any Jurisdiction (intial ) .

For Affiliations and Dual Memberships ONLY (Check One) I am a _____ Current  ____ Demitted member of
the Valley of                                                              Located in

OPTIONAL  INFORMATION Note: Your personal information is not shared outside the Fraternity.

Business Address

Home Telephone (          )           -                                Business Telephone (          )             -

Cell Phone #        (           )          -                                 Fax Number (        )

Email Address