REQUEST for LETTER of GOOD STANDING

Brethren;
I, (Name) ____________________________________________________ (Member No)._____________________
do hereby request that a Letter of Good Standing be issued to me for the purpose of Affiliating with the Kansas
City Valley of the Scottish Rite, Orient of Missouri of the Southern Jurisdiction of the United States.
My current residence is:
Residence _____________________________________________________________________________ Phone (____) ____-______
(address) (city) (state) (zip)

Member of Valley:_____________________________________ (City) Orient: _____________________________ (State)

Signed ________________________________________________ Date _____/_____/________

Scottish Rite
1330 Linwood Blvd
Kansas City, MO 64109-1935
Ph. (816) 561-2277 FAX (816) 561-1615
www.scottishrite-kcmo.org