Suspension/Expulsion Notification
Grand Lodge A. F. & A. M. of North Dakota
Date Of Change:
Grand Lodge Member ID No.:
Lodge name:
Lodge No.:
Member's name:
Last
First
Middle
Check One of the following
Nonpayment of Dues (NPD):
Un-Masonic Conduct:
Date of Suspension
Date of Expulsion:
Expelled:
Current Address
Address:
City, State, Zip:
,
Submitted By