Request for Certificate of Affiliation Please prepare and send a Certificate of Affiliation (Form 191) Rank Bro. W. Bro. V.W. Bro. R.W. Bro. M.W. Bro. First Name Last Name Grand Lodge. Number The Member will be Affiliated to Lodge Name Lodge Number Certificate Required by - Date Certificate Requested by - Name Certificate Requested by - email Special Instructions Ship to - Street Ship to - City Ship to - Province Ship to - Postal Code Send
