Change in place of meeting

DISPENSATION FOR A CHANGE IN PLACE OF MEETING

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YOUR DETAILS
Forename(s)
Surname
ELPGL computer number (if known)
Office (if not* Secretary / Scribe E)*
e-mail address

YOUR LODGE / CHAPTER DETAILS
Lodge or Chapter ?
Name
Number

DISPENSATION REQUIREMENTS

Regular meeting details
Regular meeting details
Regular meeting place

Proposed meeting place

Special circumstances warranting the request for a Dispensation

Any additional comments