Petition for the Degrees as Conferred in the Chapter
To the Excellent High Priest, King and Scribe and Companions of
_________________ Royal Arch Chapter No. ______
__________________, VA
Date: __________________________
The Subscriber (full name) ___________________________________________________________________,
a Master Mason in good standing and a member of ________________________________________________ Lodge No. ____________ at _____________________________________________, State of _____________
by occupation a ____________________________________________________________________________
residing at _________________________________________________________________________________
having been a resident of your jurisdiction for the past year, respectfully petitions for the Degrees as conferred in the Royal Arch Chapter, and declares that he has ________ been rejected by _______________ Royal Arch Chapter, and pledges himself that, should his petition be granted, he will cheerfully conform to all the requirements of Royal Arch Masonry in general, and of this Chapter in particular.
Date of Birth: ___________________ Signature: _________________________________________________
Full Name (Print or Type): ___________________________________________________________________
Home Phone: ______________________ Work: ______________________ Cell: ______________________
Email: _____________________________________ 2nd Email:_____________________________________
Other Lodges: ______________________________________ No.________ at __________________________
______________________________________ No.________ at __________________________
______________________________________ No.________ at __________________________
Recommended and vouched for by Companions:
_______________________________________________, __________________________ Chapter # ______
_______________________________________________, __________________________ Chapter # ______
Deposit fee of $_______ must accompany petition (Total degree fees $________)
For Chapter Secretary Use:
Presented _____________ S. & R. M. ______________
Elected _____________ M. E. M. ______________
M. M. _____________ Royal Arch ______________
P. M. _____________