Knights of Saint Andrew
Valley of Lander Chapter of Lander
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 Lander Chapter of Lander for the Ancient & Accepted Scottish Rite Valley of Lander. 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, 569 Garfield Street Lander, WY 82520
Official Use Only: Date Verified with Valley:_____________
Date Application & Payment Received:_________________Petition Approval Date:______________
Date of Knighting:____________________