Grand Lodge Directory Report Form

PLEASE GIVE INSTALLATION DATE OF LODGE OFFICERS:

MM

DD

YYYY

Lodge Officer

Exalted Ruler

President

Exalted Ruler / President - Name

First Name

Last Name

Spouses Name (optional)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone #

(###)

###

####

Fax #

(###)

###

####

Secretary Name

First Name

Last Name

Secretary's Spouse Name (optional)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone #

(###)

###

####

Fax #

(###)

###

####

Hall/Facility Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone of Hall/Facility

(###)

###

####

Does Lodge Have A Lounge?

Yes

No

Lounge Phone #

if applicable

(###)

###

####

Lodge Correspondence Should Be Sent to:

Secretary Address As Indicated In Section 2

Lodge/Facility Address As Indicated In Section 3

Would you like to receive accounting forms (ie. invoices, statements, etc) via email?

Yes

No

Publicity Director Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone #

(###)

###

####

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####