Palmyra Chapter Lifetime Honorary Membership Form

Online Petition for Lifetime Honorary Membership in Palmyra Historical Chapter No. 2
Date*

MonthDayYear
Date
To the Officers and Members of Palmyra Chapter No. 2, I, the undersigned, being a Royal Arch Mason in Good Standing in:
Chapter Name*
enter chapter name
Chapter No.*
enter chapter number
Located at:*
enter chapter city
under the jurisdiction of the Grand Chapter of Missouri, certify that I have resided within the jurisdiction for the past twelve months, and do respectfully petition for the lifetime honorary membership in Palmyra Historical Chapter No. 2.

Lifetime Honorary Membership in Palmyra Chapter No. 2 is $50.00 which amount must accompany this petition.

Petitioner Must Provide Detailed Information Below.
Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Chapter Member Number*
from chapter dues card or MMS
Home Phone
Cell Phone
Date of Birth*

MonthDayYear
Date
Email Address*
example@example.com
You will be directed to PayPal to complete your purchase. Your membership application is not complete without payment. Includes $5:00 processing fee.
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Online Petition for Lifetime Honorary Membership in Palmyra Historical Chapter No. 2