Out-of-STATE - Grand Assembly Registration Form

Let Your Inner Star Shine with Rhode Island Rainbow

Last Day for Registration - May 17, 2025
RI Grand Assembly Registration Form

Please fill out all fields marked with the RED star. Payment can be taken at the end of this form OR by check. ALL mailed in checks MUST be POST MARKED by May 17th. READ ALL DISCLAIMERS ON THE WEBPAGE BEFORE FILLING THIS FORM OUT.
Basic Info
Your Name*

PrefixFirst NameLast Name
Email Address
example@example.com
Contact Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Assembly:*

Pawtucket #3East Greenwich #4South Kingstown #6Westerly #7Woodridge #10Warwick #15Out-of-State
Jurisdiction:
Adult Contact Info*

NamePhone Number
ROOM RATES PER NIGHT:

Please note, roommates listed are NOT guaranteed.
Room Rates (per night including you):*
Which Nights? (Thurday, Friday, and/or Saturday)

Thursday Night (Only for qualifying persons)Friday NightSaturday Night
Rate Total:
Roommate 1:

PrefixFirst NameLast Name
Roommate 2:

PrefixFirst NameLast Name
Roommate 3:

PrefixFirst NameLast Name
Roommate 4:

PrefixFirst NameLast Name
Meals:

Banquet is complimentary to Supremes, Grand Worth Advisors and Grand Representatives to RI. PLEASE Select OTHER if you fall under one of these titles.
Options:*

Friday Opening Night Sweet Treats (Girls) - $0Friday Opening Night Sweet Treats (Adults) - $18Saturday's FEED ME Seymour! Breakfast - $25Saturday's Ladies Who Lunch Deli Plate - $28Saturday's Final Bow Banquet - $25-$40Sunday's Break a Leg Breakfast - $25Other
Banquet Meal

Select OTHER if you are NOT attending the banquet and do NOT require a meal
Options: *
ALLERGIES/DIET RESTRICTIONS:
Meal Totals:
Introduction Card

Introduction Card (Use blank field below to fill out official title. (I/e. Select Grand Representative and then fill the field with the jurisdiction.) If your option is not available, please select other.
Options*

Supreme OfficerSupreme InspectorSupreme DeputyGrand Worthy Advisor (jurisdiction)PGWA (jurisdiction & year)Grand Officer (jurisdiction & office)Grand RepresentativeGrand Executive CommitteeJr. Grand Executive CommitteeGrand DeputyDeMolay (title/office)Mother Advisor/Worthy AdvisorOther
Official Title
T-Shirts

Short and Long Sleeves Available for Most Sizes
Pre Order '25-'26 T-SHIRTS: Short Sleeve*
Quantity:
Short Sleeve Total
Pre Order '25-'26 T-SHIRTS: Long Sleeve*
Quantity:
Long Sleeve Total
Registration and Official Grand Assembly Credits

Select "$0" if you are a SUPREME, a GRAND WORTHY ADVISOR, and/or a GRAND REPRESENATIVE TO RI for Registration to be waived.
Registration
Official Grand Assembly Credits: (Obtain this amount from your Mother Advisor)
Would you like to be added to our email mailing list?

YesNo
Email Address
example@example.com
TOTAL DUE:
Payment Method

Credit CardCheck
Total Due:

Registration Chair Person

Mrs. Bonnie Dunford -401-636-2798 - RIGRANDASSEMBLYREG@gmail.com
Should be Empty:

Let Your Inner Star Shine with Rhode Island Rainbow

RI Grand Assembly Registration Form

Basic Info

ROOM RATES PER NIGHT:

Meals:

Banquet Meal

Introduction Card

T-Shirts

Registration and Official Grand Assembly Credits

Total Due:

Payment Methods

Registration Chair Person