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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



Date of request: Month Day Year
Lodge:
Lodge No.
City:


To The Grand Lodge of A.F. & A.M. of Oregon:

Application is hereby made for a Fifty-Year Emblem to be presented to a member of this Lodge. We furnish the following data for your information.

Full Name:
Computer No.
Mailing Address:
Place of Birth:
Date of Birth: Day Year
Date of Affiliation:
Date of MM Degree: Day Year
Lodge in which Degrees Received:
Lodge No.
Lodge Located in City of:
Lodge Located in State of:

The Emblem will be mailed to the Worshipful Master.

The resolution adopted June 17, 1955 by the Grand Lodge, provides "That the required membership may be intermittent, part may be in other Grand Jurisdictions, but must total fifty years."

LAPSE OF TIME MUST BE DEDUCTED DUE TO NPD, WITHDRAWAL OR DEMIT.To compute the fifty years in good standing, only such time may be used where the member has been paying dues or has had his dues remitted.

The Code DOES NOT permit the presentation prior to the completion of Fifty-Years membership in good standing.

WE CERTIFY that this member is worthy of this honor, that we have reviewed his record and have determined that he has at least fifty years of good standing as a M.M., and in all other ways has complied with the resolution adopted by the Grand Lodge on June 17, 1955.

Worshipful Master:
Secretary:

PLEASE REPORT THE PRESENTATION AS SOON AS POSSIBLE IN ORDER THAT IT MAY APPEAR IN THE PROCEEDINGS OF THE FISCAL YEAR.

Please apply for all your 50-Year Awards at the first of the year. Allow 4 weeks to process an in-state request. Depending on the jurisdiction, an out-of-state request can take 12 weeks or longer to process.



I am finished and ready to send this information to the Grand Lodge. Press below to send.

If you have comments or questions about completing this form please call us or e-mail the Grand Secretaries Office

Thank you!