APPENDIX 1

Details of the Celebration - For completion by the Lodge Secretary:

Please select your District
Sid Fred Jim Accrington Ashton Audenshaw Blackburn Bolton Burnley/Pendle Bury Derby Oldham Rochdale Rossendale Salford Starkie Sykes
Your name (in full)

Your ELPGL computer number (if known)

Name of Lodge
and number of the Lodge
Your position (If NOT Secretary)

Recipient’s name (in full)

Preferred name (for the Certificate)

Recipient’s ELPGL number (if known)

Number of years continuous service

Rank

Name of Mother Lodge
and number of Mother Lodge
((If different from the Current Lodge)
Initiation Date (dd/mm/yyyy)

Celebration Date (dd/mm/yyyy)

APGM

Place of the celebration

Most appropriate type of celebration:
(A) Formal
(B) Low Key
(C) Private Presentation by the APGM
(D) Private Presentation by the Lodge Members
(E) Post the “Illuminated Certificate” and “Congratulatory Letter” to his home

Any additional comments:

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