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Order Form for Supplies

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2150 Masonic Way
Forest Grove, OR 97116
(503) 357-3158
(800) 970-9920
Office hours: 8:00 am to 5:00 pm M-F

Report Administration
Date of this report: Month Day Year
Lodge Name & Number:
Report Month:
Your Full Name:
Title
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Please complete applicable information forms you want to report to the Grand Secretary:

Degree Reporting

Degree Report No. 1
ID No:
Full Name:
DOB:
Place Birth:
EA Date:
FC Date:
MM Date:
Complete Address:

Degree Report No. 2
ID No:
Full Name:
DOB:
Place Birth:
EA Date:
FC Date:
MM Date:
Complete Address:

Degree Report No. 3
ID No:
Full Name:
DOB:
Place Birth:
EA Date:
FC Date:
MM Date:
Complete Address:

Affiliation

Affiliation Report No. 1
Full Name:
Date Admitted:
Date Birth:
Place Birth:
Type of Affiliation: Dual (in-state only)
Transfer (complete fields below)
From Lodge: ,No.
State
Full Address:
Designations: Past Master
Fifty year Member
EA Date:
FC Date:
MM Date:
In-state Only:
(check only one)		 Dual Transfer

Affiliation Report No. 2
Full Name:
Date Admitted:
Date Birth:
Place Birth:
Type of Affiliation: Dual (in-state only)
Transfer (complete fields below)
From Lodge: ,No.
State
Full Address:
Designations: Past Master
Fifty year Member
EA Date:
FC Date:
MM Date:
In-state Only:
(check only one)		 Dual Transfer

Reinstatements

Reinstatement Report No. 1
Full Name:
Date:

Reinstatement Report No. 2
Full Name:
Date:

Rejections

Rejections Report No. 1
Full Name:
Date:

Rejections Report No. 2
Full Name:
Date:

Transfers from this Lodge to Other Oregon Lodges

Transfers Report No. 1
Full Name:
Transferred to Lodge: , No.
Date:

Transfers Report No. 2
Full Name:
Transferred to Lodge: , No.
Date:

Demits, NPD'S, Deaths, Withdrawal, Severance, Suspended or Expelled

Status Report No. 1
Full Name:
ID No.
Category:
Date:

Status Report No. 2
Full Name:
ID No.
Category:
Date:

Status Report No. 3
Full Name:
ID No.
Category:
Date:

Status Report No. 4
Full Name:
ID No.
Category:
Date:



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Thank you!