RGLOWI Meetings

Constitution

Region

Lodge Name Lodge Name (for GLI members)

APPLICATION No

Title

Name*

Address*

City*

State *

Pin *

Mobile*

Whatsapp (if different from Mobile)

Email *

REGISTRATION PARTICULARS

Registration

Registration Amount

SPOUSE DETAILS

Patrons, Donor Patrons and Governors are eligible for complimentary food coupons for their spouse.

Name *

Mobile *

TRAVEL

After selecting the date, click on the clock icon at the base to select the time

Arrival Date and Time

Arrival Mode

Arrival Description

Departure Date and Tim

Departure Mode

Departure Description

FOOD PREFERENCE

Saturday

Mason

Spouse

Sunday

Mason

Spouse

EMERGENCY CONTACT

Contact Person Name

Contact Mobile No

SPECIAL INSTRUCTIONS

Any request / special medical condition to be aware of

REMITTANCE PARTICULARS

For delegates paying online; please select the name of the bank from which you have transfered the funds

Payment Type *

Cheque No/Online Transaction No*

Bank Name*

Amount

INSTRUCTIONS

Cheque should be drawn in favor of Masonic Fraternity of Bhopal

In case of payment by Cheque / Demand Draft, kindly mention your NAME and LODGE ID on the reverse of the Cheque / DD

In case of ONLINE TRANSFERS, please select the Bank Name from which you have made the transfer.

BANK DETAILS for online transfer are as follows : Account Name - Masonic Fraternity of Bhopal | Bank of India, Arera Colony, Bhopal - 462016 | Account No.: 900210210000050 | IFSC :BKID0009002 |MICR Code :462013007

REGISTRATION FORM