Ancient and Accepted of Valley of Macon Georgia & Shriners International Al Sihah Shrine Center of Macon, Georgia

Petition for Scottish Rite & Shrine Degrees

To the Officers and Members of the Scottish Rite Bodies and/or Shrine, the undersigned, a Master Mason in good standing of ______Lodge, No.______, F. & A.M. located at ______under the Jurisdiction of the of ______, and being a resident within the bounds of the Southern Jurisdiction of the Scottish Rite and/or Al Sihah Shrine, respectfully petition to receive the Scottish Rite Degrees in this Valley and/or Al Sihah Shrine and promise always to bear true faith and allegiance to the Supreme Council of the Thirty Third Degree of the Southern Jurisdiction of the of America and/or Shriners International. PRINT FIRST NAME: PRINT MIDDLE NAME: PRINT LAST NAME:

As a basis for the consideration of this petition, I truthfully make the following statements: I was made a Master Mason in ______, ______at ______Month & Day Year City or County State or Providence Country If less than 6 months, have you stood proficiency on the Masters Degree? Y / N I was born, ______at ______Month & Day Year City or County State or Providence Country

HOME & PERSONAL INFORMATION BUSINESS INFORMATION Address: My Vocation: City: My Employer: State & Zip: Address: My Hat Size: City: I prefer to be contacted at Home / Business State & Zip: Wife’s Name If retired, type of Business

TELEPHONE, FAX, & EMAIL INFORMATION Home: Cell: Business: Email: Website: FAX:

Have you previously petitioned for or been proposed as a candidate for the Scottish Rite and /or Shrine Degrees? Y / N (If so state when, where, and to whom application was made) ______Have been rejected by any Masonic body? ______(If yes give full name of body and particulars). ______

The Supreme Council and Shriners International announces and requires 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 approve wholeheartedly of these principles? Y / N

Have you ever expressed opinions contrary to the foregoing or been affiliated with any organization which has? Y / N (If yes give particulars), ______At ______, ______, ______, ______Organization City State Date RECOMMENDED BY (SHOULD ACCOMPANY CANDIDATE ON DEGREE DAYS) Print Full Name SR / SHRINE NUMBER SIGNATURE

MUST BE RECOMMENDED BY TWO (2) MEMBERS OF THE SCOTTISH RITE AND/OR THE SHRINE OR BY THE WORSIHPFUL MASTER OF YOUR BLUE LODGE UNDER THE SEAL OF THE LODGE

PETITIONERS SIGN NAME IN FULL DATE

BODY BEING PETITIONED (PLEASE CHECK THE APPROPRIATE BOX) SCOTTISH RITE SHRINE BOTH

FEE lNFORMATION Fees for the Bro. Harry A. Bruno Memorial Reunion/Ceremonial is $90.00 for the Scottish Rite this fee which includes 2016 dues, the English Patent (suitable for framing) signifying your status, and the 32° Degree Cap and $85.00 for the Shrine fee which includes 2016 dues. Make checks payable to the MACON LODGE OF PERFECTION and/or AL SIHAH SHRINE CENTER and include it with your completed petition. The petition may be returned to the Valley of Macon by the Recommenders, or by mail to the following address: MACON SCOTTISH RITE, P.O. Box 4505, MACON GA, 31213-4505.

This Form is effective ONLY for the Bro. Harry A. Bruno Memorial 2016 Spring Reunion/ Ceremonial.