Lodge Charity Account Application

Lodge Charity Account Application

Lodge Name*

Lodge Number*

ContactLodge Charity Account Representative (LCAR)*

LCAR Full Address (Include City, State and Zip)*

LCAR email*

LCAR Phone*

Project Category*

Select

Project Description, Preservation or Almoner Name*

Date of Event/Presentation (if you have one)

Amount of Request*

Check Made Payable to: (Recipient Name)*

Recipient Address*

Recipient City*

Recipient State*

Recipient Zip*

Minutes from business meeting approving the withdrawal*

Drag and drop files here or

Date Submitted*

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