Dispensation Request Form

Dispensation Request Form
Email*
example@example.com
Choose Action*

Request Dispensation
Select Lodge or Chapter*
Select Email*
Event Details
Name of Event*
Event Type*
Description of Event*
Include Event Location, and the Insurance Policy Number (If Required)
Event Date*

MonthDayYear
Date
Event Start Time*

Hour Minutes

AM/PM Option
Event End Time*

Hour Minutes

AM/PM Option
DDGM Approve Event

(DDGM ONLY)
Event Approved or Declined (DDGM ONLY)

ApprovedDeclined
DDGM Comments
Should be Empty:

Event Details