Reclamation Form Page

Full Name

Address

Contact Phone Number

Email Address

I was advanced/elevated on

In Consistory #

Located in

The last Consistory in which I held membership was.

Did you receive a reinstatement letter? Did you receive a reinstatement letter? (I Did) (I Did Not)

The Lodge I last held membership was/in:

Lodge #

of the MWPHGL of and its Jurisdiction.

My Lodge membership is current as of