Lodge Directory Report

Installation Date of Officers *

MM

DD

YYYY

Please choose position to report: *

Exalted Ruler

President

Honoured Royal Lady

Secretary

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Hall or Facility Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Does your Lodge have a lounge?

Yes

No

Lounge Phone No. (if applicable)

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Would you like to receive accounting forms via email?

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country