Lodge Certification Form

Lodge Certification Report

Lodge:	*
Deputy Grand Custodian:	*
Deputy Grand Custodian Email:	*
Lodge City:
Date of Examination: * * *
Type of Certification: *
Remarks:


If provided, the following information will be printed on the lodge certificate:
Worshipful Master:
Senior Warden:
Junior Warden:
Secretary:
Treasurer:
Chaplain:
Senior Deacon:
Junior Deacon:
Senior Steward:
Junior Steward:
Marshal:
Organist:
Tyler:
List all names for Stations, Craftsmen and Lectures in text boxes below:
Stations:
Craftsmen:
Lectures:
Comments:



Upon clicking Submit Application, the report will be emailed to the Grand Lodge, and a copy sent to the email you provided above. If you don't see the confirmation page after clicking Submit Application, scroll up and verify that all required fields (noted with asterisks) have been filled in or an item chosen from the dropdown box.