INITIATION FEE $______Petition for Chivalric Orders

To the Eminent and Sir of ______Commandery No. ______, of California: The undersigned respectfully represents that he is a member in good standing of ______Lodge No. ______, F. & A. M., under the jurisdiction of the of ______; that he is a member in good standing of or has petitioned to receive the Capitular Degrees in ______Chapter No. ______, R. A. M., under the jurisdiction of the Grand of ______; that he is a member in good standing of or has petitioned to receive the Cryptic Degrees in ______Council No. ______, C. M., under the jurisdiction of the Grand Council of ______; that he desires to receive the Orders of Knighthood; that he is a firm believer in the Christian religion; that he has been a resident of the State of California for six months next preceding the date of this petition; that he has not, within six months past, made application to and been rejected by any Commandery of Knights Templar;* and that he promises, if found worthy, to conform to all usages, customs, laws and regulations of the above named Commandery and the Grand Commandery of Knights Templar of the State of California. ______* If such application has been made, state the name and location of on the line above.

Place of Birth: ______

Date of Birth: ______

Occupation: ______

Residence Address: ______City: ______State: _____ Zip+4: ______

Residence Phone: ______

Business Address: ______City: ______State: _____ Zip+4: ______

Business Phone: ______Print Name: ______First Name Middle Name Last Name Dated: ______Signature: ______

4444444444444444444444444444444444444444444444 4444444444444444444444444444444444444444444444 RECOMMENDED BY: REFERS TO: Sir ______Name: ______

Address: ______Address: ______City: ______Phone: ______City: ______Phone: ______

Sir Knight ______Name: ______Address: ______Address: ______

City: ______Phone: ______City: ______Phone: ______4444444444444444444444444444444444444444444444 4444444444444444444444444444444444444444444444

Elected: ______Knight of Malta: ______

Red Cross: ______Knight Templar: ______