SCOTTISH RITE REGIONAL REUNION

May 12 - 15 2010 – Chaparral Suites Resort, Scottsdale, AZ

REQUEST TO CONFER COURTESY WORK

NOTICE:  Request must be postmarked not later than May 1^st, 2010[1]

Please type or print everything except signatures!

Use one form for each Candidate

 

________________________ Orient

 

________________________ Valley

 

 

To:   Ted Shima, Candidate Registrar (602) 212-1073 x-204

      Phoenix Scottish Rite Bodies            

      14001 N. 7th Street, Suite F-111, Phoenix, AZ 85022

      Phones: 562-435-8381, 714-633-1920
 

Dear Brethren:

      Please confer the Degrees of the Scottish Rite Bodies indicated below on the following candidate, who has been)(will be) elected to receive them.

 

NAME: _______________________________________________________________

 

ADDRESS: ____________________________________________________________

 

CITY/STATE/ZIP: _____________________________________________________

 

PHONE (with A/C) ___________________________

 

Please check Degrees and Orders to be conferred:

      |__|  Lodge of Perfection:    04^th thru 14^th Degrees

      |__|  Chapter of Rose Croix:  15^th thru 18^th Degrees

      |__|  Council of Kadosh:      19^th thru 30^th Degrees

      |__|  Consistory:             31^st thru 32^nd Degrees

 

I certify that the above-named Candidate (has been)(will be) elected to receive the Degrees of the Bodies indicated, and that he is in all ways duly qualified.  (If he has not yet been elected, I will notify the Candidate Registrar if he fails to be elected before the Reunion.)

 

SIGNATURE: _______________________________________________________________

 

SECY-REC NAME: ___________________________________________________________

 

MAILING ADDRESS: _________________________________________________________

 

CITY/STATE/ZIP: __________________________________________________________

 

PHONE (with A/C): ________________________________________________________