Petition for Restoration

Scottish Rite - San Diego
Petition for Restoration!
Ancient & Accepted Scottish Rite, Southern Jurisdiction, USA

Please provide the following information:

To the Officers and Members of the Scottish Rite Bodies, Valley of San Diego, Orient of California,
I, whose name appears below, respectifully petition for the restoration of my membership to these
Bodies.

Enter your Full Name (Initials not sufficient)

First Name:

Middle Name:

Last Name:

Present Address:

City:

                9 Digits Required

State:
Zip:

Phone:

E-mail:

Date of Birth:

City:
   State:

Wife's Name:
Anniversary:

Social Security Number:

Scottish Rite Information:

I was a member of:
San Diego Scottish Rite Bodies Other

If other:
   Valley Orient

When?

Blue Lodge Information:

I am now a member of:
Blue Lodge:   Number:

Located at:
State:

Date Raised:

Are you a Past Master?
Yes   No

If so, Where?
   When?

Give in Detail. If retired, state former occupation:

Profession or Occupation:

Employer:

Employer Phone:

Hobbies or Interests:

Upon receipt of this Petition for Restoration by Scottish Rite Bodies, San Diego,
a member of the Restoration committee will contact you.

SCOTTISH RITE BODIES SAN DIEGO
1895 Camino Del Rio South
San Diego, California 92108-3683
(619) 293-4888

	*Enter your Full Name (Initials not sufficient)*
First Name:
Middle Name:
Last Name:
Present Address:
City:
	*9 Digits Required*
State:	Zip:
Phone:
E-mail:

Date of Birth:
City:	State:

Wife's Name:	Anniversary:
Social Security Number:

	*Scottish Rite Information:*
I was a member of:	San Diego Scottish Rite Bodies Other
If other:	Valley Orient
When?

	*Blue Lodge Information:*
I am now a member of:	Blue Lodge: Number:
Located at:	State:
Date Raised:
Are you a Past Master?	Yes No
If so, Where?	When?
	Give in Detail. If retired, state former occupation:
Profession or Occupation:
Employer:
Employer Phone:

Hobbies or Interests: