Form

Ill. Sir Jim Covington, Jr is planning his calendar for 2012. He will be visiting all clubs and units during the year. To request a special visit in 2012 for officer installation or other special events, please use this online form to request your dates. Review the online calendar on the Amran website to see if the potentate is available on the date you are requesting. All official visitations are listed inRED on the online calendar.

A response will be sent to your email when confirmed.

Club, Unit or Organization Name*

Contact Name:*

E-mail:*

Phone: include Area Code*

Date Requested for Visit in 2012*

/ Month / Day Year

Time of Event*

Place of Event*

Address of Event*

Type of Event?*

Dress Code (business casual, suit & tie, formal, etc)*

Dinner Served*

Are Ladies Welcomed at this meeting?*

Additional Comments: Social hour, other times.

Do you want the Divan invited also?*

Yes

All requests will be confirmed via email when received.