Last Name  _____________________________________________

First Name  _________________Spouse Name______________
Middle   __________________
Nick Name or Name Preferred _______________

Street Address ____________________________

City   _______________________  State _____________
   
ZIP   _____________            E-Mail ________________

Residence Phone ______________  Work Phone ____________

I respectfully request membership in the Scots Guard and agree to abide by the by-laws of the organization and pledge myself to building friendship by working together in Freemasonry.  My one time fee of $15.00 is enclosed.  I understand there are no dues but that I must have a black 32° degree cap.

Fees $ 15        Black Cap  $ 40    Cap Case $ 15        TOTAL ENCLOSED  $_________________________

Signed __________________________________________    Date __________________


Recommended by: _______________________________________, One  Scots Guard Member
                  or Two Scottish Rite Masons

                  and        _______________________________________
Make Check Payable To:   Scots Guard/Scottish Rite, Valley of Covington
     
Return to:  Thomas E Buschle, 32°  Secretary/Treasurer    
                   Scots Guard, Valley of Covington
                   6315 Filly Ct,   Independence, KY 41051
  Phone 363-7570    EMAIL  covsr.webmaster@fuse.net