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  • Officer Roster Form

    Officer Roster Form

    Please provide the following contact information (* = Required Field):

    Lodge Name/Number: *
    Lodge Address:
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    Lodge Phone:
    Lodge FAX:
    Lodge Officers Term Begin: (mm/dd/yy) *
    Lodge Officers Term Expire: (mm/dd/yy) *
    Lodge Meeting Date: (mm/dd/yy) *

    President's Information

    President:
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    Home Phone:
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    Email:

    Vice-President's Information

    Vice-President:
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    Zip Code:
    Home Phone:
    Work Phone:
    Email:

    Secretary's Information

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    Email:

    Treasurer's Information

    Treasurer:
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    Zip Code:
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