Scottish Rite, NMJ - Membership Application

Personal Details

Prefix

First Name

Please enter your first name.

Middle Name

Please enter your middle name.

Last Name

Please enter your last name.

Suffix

Nickname

Name Format

Please select a name format.

Date of Birth

Are you retired?

Yes

Occupation

Please enter your occupation.

Employer

Please enter your employer.

Are you a Veteran or Active Military?

Yes

Service Branch

Please select a service branch.

Service Start Date

Please enter a service start date.

Service Type

Please select a discharge type.

Ending Term of Service Date

Please enter an Ending Term of Service date.

Address

Address 1

Please enter your address.

Address 2

Zip

Please enter your zip code.

City

Please enter your city.

State

Please select a state.

County

Please select a county.

Contact Info

Please enter your email.

Home Dial Code

Home Phone

Cell Dial Code

Cell Phone

By checking this box, I agree to receive information, reminders, and alerts from Scottish Rite at the phone number provided. Message and data rates may apply. Reply HELP for help or STOP to cancel. View SMS Terms of Service

You must agree before submitting.

Work Dial Code

Work Phone

Work Ext.

Preferred Phone

Application Details

In order to join the Scottish Rite, you must select a home valley based on your personal preference. Please also indicate a recommending brother, or alternatively upload a photo of your symbolic lodge dues card using the upload button below.

Please select which Valley you are petitioning

Symbolic Lodge Name and Number