Limited Dispensation Form
Grand Lodge, A.F. & A.M., of Virginia. 4115 Nine Mile Road Richmond, Virginia 23223-4926
Grand Secretary, Alan W. Adkins, PGM 804-222-3110 grandsecretary@glova.org
District Deputy Grand Masters http://ddgm.vamasons.org
REV. E04-15
DDGM Information:
Email *
Your email address. The form will be emailed to all email addresse(s) entered. Comma "," separated.
Your answer
Name
DDGM full name
Your answer
District
Masonic District No. i.e. 3, 54, 1B. Do not use St. Nd. Rd.
Your answer
Lodge Information:
Worshipful Master
Worshipful Masters full name
Your answer
Lodge Name
Name only. Do not use "Lodge"
Your answer
Lodge Number
i.e. 123. Do not use No. or #.
Your answer
From: Day, Month, Date, Year, Time, and Location.
Current per Lodges Bylaws.
From Day *
From Month *
From Date
i.e. 3rd, 13th, 23rd
Your answer
From Year
i.e. 2000 yyyy
Your answer
From Time
i.e. 7:30pm
Your answer
From Location
Town or City (current communication location as in bylaws)
Your answer
To: Day, Month, Date, Year, Time, and Location.
Move to new Day, Month, Date, Year, Time, and Location.
To Day *
To Month *
To Date
i.e. 3rd, 13th, 23rd
Your answer
To Year
i.e. 2000 yyyy
Your answer
To Time
i.e. 7:30pm
Your answer
To Location
Town, City or Place. "Same" if no change
Your answer
How Members Notified.
This change was communicated to the members by *
Select all that apply
Required
Comments
i.e. reason for request ("severe weather") and other comments
Your answer
After you click submit, this form will be emailed to you as an attached PDF.
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