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.
Name
DDGM full name
District
Masonic District No. i.e. 3, 54, 1B. Do not use St. Nd. Rd.
Lodge Information:
Worshipful Master
Worshipful Masters full name
Lodge Name
Name only. Do not use "Lodge"
Lodge Number
i.e. 123. Do not use No. or #.
From: Day, Month, Date, Year, Time, and Location.
Current per Lodges Bylaws.
From Day *
From Month *
From Date
i.e. 3rd, 13th, 23rd
From Year
i.e. 2000 yyyy
From Time
i.e. 7:30pm
From Location
Town or City (current communication location as in bylaws)
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
To Year
i.e. 2000 yyyy
To Time
i.e. 7:30pm
To Location
Town, City or Place. "Same" if no change
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
After you click submit, this form will be emailed to you as an attached PDF.
Submit
Never submit passwords through Google Forms.
This form was created inside of Grand Lodge of Virginia. Report Abuse
Google Forms