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:____________________ |
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