Dispensation request

Please complete this form to send a dispensation request to the Provincial office in Leyland.

Your name (required)*
First Last
Your email (required)*
Name of your lodge/chapter/group (required)*
Your lodge / chapter number (required)*
Please click the relevant radio button (required)*
I am applying on behalf of
- Lodge
- Chapter
- Group
What are you applying to do? (required)*
I am applying for a dispensation to do the following:
Your role/office (required)*
Please click the relevant radio button
- I am the lodge secretary/chapter scribe Ezra
- I am NOT the lodge secretary/chapter scribe Ezra
Reason for the dispensation request (required)*
The reason(s) for the application is as follows:
Date of meeting*
What is the date of the meeting you require the dispensation for?
I have notified the group chairman of this dispensation application*
- Yes
Please enter the address you want the dispensation to be posted to:
Address (required)*
Street Address City County / State / Region ZIP / Postal Code
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