Knights of Saint Andrew

Valley of Cheyenne Chapter of Cheyenne

Ancient & Accepted Scottish Rite

The Motto of the KSA…. “ Service and Leadership”

Petition for Membership

Print Full Name________________________________________________

Mailing Address________________________________________________

City, State, Zip Code_____________________________________________

Home Phone_____________________ Work Phone____________________

Cell Phone_____________________ Email__________________________

Blue Lodge(Mother)_____________________________________________

Scottish Rite Valley &Orient _______________________________________

DECLARATION OF MEMBERSHIP

I hereby apply for membership in the Knights of Saint Andrew, Valley of Cheyenne Chapter of Cheyenne for the Ancient & Accepted Scottish Rite Valley of Cheyenne. Upon active membership, I will commit to service to the Valley as my cabletow permits. Furthermore, I swear I am in good standing with my Masonic Lodge as well as the Scottish Rite Valley, of which I am a member.  

Full Signature of Petitioner _________________________________Date_______

All Fees & Dues Payment MUST Accompany this Petition

Petition Fee $50 + Current Year Dues $20= Total of $70

Deliver or Mail Petition Payment to:

Knights of Saint Andrew, 1920 Capitol Ave, Cheyenne, WY 82001

Official Use Only: Date Verified with Valley:_____________

Date Application & Payment Received:_________________Petition Approval Date:______________

Date of Knighting:____________________