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SalutationHow would you like to be addressed?

First Name *

Last Name *

Birthdate *

Phone *

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Home Lodge Name *

Jurisdiction *Your home lodge's jurisdiction under SGL

Secretary or Noble Grand Email Address *This address may be contacted to verify your membership in your home lodge

Secretary or Noble Grand Phone Number *This person may be called to verify your membership in the home lodge

Current DegreeWhat is the highest degree you have received?

Have you joined an encampment?I am a member of an encampment

Name, Number and Jurisdiction of Your Encampment

Have you joined a canton?I am a member of the Patriarchs Militant

Name, Number and Jurisdiction of Your Canton