MWPHGL of IN Special Session Registration

Most Worshipful Prince Hall Grand Lodge of Indiana Special Session on June 19, 2021 Registration Form

Registration Fee is $20.00. Registration Deadline is June 12, 2021.
Lodge Title *

Past Master Worshipful Master Senior Warden Junior Warden Master Mason
Name *

First Name Middle Name Last Name Suffix
E-mail *
Lodge Name *
Are you an Elected GL Officer *

Yes No
Are you an Appointed GL Officer *

Yes No
Address *

Street Address

Street Address Line 2

City State

Zip Code
Mobile Phone Number *
Home Phone Number if different from above
Do you prefer to receive Grand Lodge Communications via E-Mail or Post Office? *
Method of Payment *

Mailing my Registration Payment to address below Cash App - use the URL below, you will not be registered until payment is received https://cash.me/$mwphglin
Your $20 Registration payment must be received before June 12, 2021. Choose a payment method below.

All payments should be made out to MWPHGL of IN if you are paying with a cashiers check, check or money order.

Mail them to the RW Grand Secretary Tyree McGraw at 5605 East 38th St., Indianapolis, IN 46218.
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Most Worshipful Prince Hall Grand Lodge of Indiana Special Session on June 19, 2021 Registration Form