Request for an Honourary Life Membership Certificate Please prepare and send an Honourary Life Membership Certificate for this Master Mason (Form 205) Rank Bro W. Bro V.W. Bro. R.W. Bro. M.W. Bro. First Name Last Name Lodge Name Lodge Number Certificate Required by - Date Certificate Requested by - Name Certificate Requested by - email Grand Lodge Officer Requested Y N Special Instructions Ship to -Street Ship to - City Ship to - Province Ship to - Postal Code Send
