Petition For The Degrees Of Freemasonry

Product Name(Required)

Payment Option

Credit Card

Cash/Check/Money Order

Total

Credit Card

Card Details

Cardholder Name

For Petitioning for Degrees Only:

(For membership dues only, please scroll to the bottom of the page to submit)

Full Name(Required)

Born at

City State

Date

Age

Citizen of Country

Home Address

Number and Street City New Mexico (Zip Code)

Mailing Address (If different than home address)

Number and Street / P.O. Box City New Mexico (Zip Code)

Home Phone

Work Phone

Cell Phone

Email Address(Required)

Residence(s) for the Past Five Years

From

Address

City

State

Present Occupation or Trade

Employer Name

Employer Address

Number and Street City State Zip Code

Employer(s) for the Past Five Years

From

Name

City

State

Full Name of Wife

Minor Dependents

Name

Age

Have you ever been convicted of a felony or are you currently under indictment or preliminary hearing bind-over for a felony? (If yes, please provide details below.)

Charge

City/State

Final Disposition

Do you believe in a Supreme Being or Deity?

The degree ceremonies consist of three degrees followed by a proficiency lecture after each degree. Will you be able to spend time with a coach to learn each proficiency lecture?

Do you understand that if you are rejected, or if you withdraw your petition, only the unexpended portion of your fee for the degrees will be refunded?

Have you ever petitioned or been rejected by this or any other Lodge of Freemasonry?

If so, when and where?

Have you any limitations or infirmities that would prevent you from participating in light physical activities?

If so, describe briefly

To what other fraternal organizations or societies do you belong?

What motive prompted this petition?

Provide at least three character references: (Other than immediate family or the Masons recommending you for membership. You may attach additional letters of reference from family members and others as you desire.)

Name

Phone

Address

Relationship

With the understanding that all information obtained shall be treated as confidential, I consent to a full background investigation

Printed or Typed Name

Date

Signature

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