Application for 50-, 60-, or 70-Year Membership Award

Complete all sections that apply

Application is hereby made for a Membership Award for:

First Name: Middle Initial: Last Name:
Application is made for a
Expected Date of Presentation:
Born:
Initiated:
Passed:
Raised:
Proficient:
Degrees in Lodge Name:  Lodge No.

Jurisdiction of:
Suspensions:
 50 Year Pin Awarded:
 60 Year Pin Awarded:
Brother's current address:
 
Please arrange for presentation by another Grand Jurisdiction or Nebraska Lodge:
      
 
It is hereby certified that this Brother is a member in
good standing of Lodge No. * 
 
   
Secretary Name:  * 
Secretary Email:   * 

 

Terms Of Use | Privacy Statement
Copyright 2010 by Grand Lodge of Nebraska

Designed by Turner & Associates.