1.

Your Name: *

2.

Your E-mail Address: *

3.

Your Council Number *

4.

ALL COUNCIL MEMBERS WHO DIED THIS YEAR --- (use semi-colon as a separator between names) -- Please indicate if the deceased member was a Bishop, Former State Chaplain, other clergy, Former State Officer, Current/Former District Deputy.

5.

50 Year Members This Past Year --- (use semi-colon as a separator between names)

6.

Your Council Position: *

7.

City of Council: *