RE-INSTATEMENT REPORT
Please fill out the following information and press the SUBMIT button.
We will invoice you for Re-Instatement Fees.
Grotto Name & Number
Supreme Council #
Prophet's Grotto #
Original Initiation Date
Enchanted Lantern Holder
YES
NO
Last Name
First Name
Middle Name
Address
Year of Birth
City
State
Zip
Top Line Signer's Name and Supreme Council #
Suspension or Demit Date
Re-Instatement Date