Apply Online, Alternate Payment Source

This form is to apply to join Richard Brouse Degree Lodge 190 without sending the payment through paypal at the same time. Presumably you paid by cash or check. However, if you have not yet paid, you won’t receive your official dues card by filling out this form. If you need to make a payment, please visit our dues application which includes a checkout.

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?

Dues Card Image

No file chosen

Upload a picture of a current dues card with your home lodge

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