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Form 10: Initiatory/DeMolay Degree Conferred

Please complete within 7 days of the degree being conferred.

If DeMolay Degree is conferred at a different date please complete include the initiatory degree date in the application.

Step 1 of 7

Chapter Name(Required)

Chapter Location(Required)

Jurisdiction(Required)

Which degree was conferred?(Required)

Initiatory Degree

DeMolay Degree

How many members received the degree?(Required)

Candidate 1 - Full Name

First Middle Last

Candidate 1 - Preferred Name

For certificates & membership card

Candidate 1 - Address

Street Address Address Line 2 City Province Postal Code

Candidate 1 - Email

Candidate 1 - Phone Number

Candidate 1 - Parent Name

First Last

Candidate 1 - Is Parent a Senior DeMolay?

Yes

Candidate 1 - Is Parent a Mason?

Yes

Chapter Name & Location

Lodge Name, Number & Location

Candidate 1 - Parent Address

Street Address Address Line 2 City Province Postal Code

Candidate 1 - Parent Email

Candidate 1 - Parent Phone Number

Candidate 1 - Birth Date

Candidate 1 - Initiatory Degree Date

Candidate 1 - DeMolay Degree Date

Candidate 1 - First Line Signer

Candidate 1 - First Line Signer ID #

If unknown please mark UKN

Candidate 2 - Full Name

First Middle Last

Candidate 2 - Preferred Name

For certificates & membership card

Candidate 2 - Address

Street Address Address Line 2 City Province Postal Code

Candidate 2 - Email

Candidate 2 - Phone Number

Candidate 2 - Parent Name

First Last

Candidate 2 - Is Parent a Senior DeMolay?

Yes

Candidate 2 - Is Parent a Mason?

Yes

Chapter Name & Location

Lodge Name, Number & Location

Candidate 2 - Parent Address

Street Address Address Line 2 City Province Postal Code

Candidate 2 - Parent Email

Candidate 2 - Parent Phone Number

Candidate 2 - Birth Date

Candidate 2 - Initiatory Degree Date

Candidate 2 - DeMolay Degree Date

Candidate 2 - First Line Signer

Candidate 2 - First Line Signer ID #

If unknown please mark UKN

Candidate 3 - Full Name

First Middle Last

Candidate 3 - Preferred Name

For certificates & membership card

Candidate 3 - Address

Street Address Address Line 2 City Province Postal Code

Candidate 3 - Email

Candidate 3 - Phone Number

Candidate 3 - Parent Name

First Last

Candidate 3 - Is Parent a Senior DeMolay?

Yes

Candidate 3 - Is Parent a Mason?

Yes

Chapter Name & Location

Lodge Name, Number & Location

Candidate 3 - Parent Address

Street Address Address Line 2 City Province Postal Code

Candidate 3 - Parent Email

Candidate 3 - Parent Phone Number

Candidate 3 - Birth Date

Candidate 3 - Initiatory Degree Date

Candidate 3 - DeMolay Degree Date

Candidate 3 - First Line Signer

Candidate 3 - First Line Signer ID #

If unknown please mark UKN

Candidate 4 - Full Name

First Middle Last

Candidate 4 - Preferred Name

For certificates & membership card

Candidate 4 - Address

Street Address Address Line 2 City Province Postal Code

Candidate 4 - Email

Candidate 4 - Phone Number

Candidate 4 - Parent Name

First Last

Candidate 4 - Is Parent a Senior DeMolay?

Yes

Candidate 4 - Is Parent a Mason?

Yes

Chapter Name & Location

Lodge Name, Number & Location

Candidate 4 - Parent Address

Street Address Address Line 2 City Province Postal Code

Candidate 4 - Parent Email

Candidate 4 - Parent Phone Number

Candidate 4 - Birth Date

Candidate 4 - Initiatory Degree Date

Candidate 4 - DeMolay Degree Date

Candidate 4 - First Line Signer

Candidate 4 - First Line Signer ID #

If unknown please mark UKN

Candidate 5 - Full Name

First Middle Last

Candidate 5 - Preferred Name

For certificates & membership card

Candidate 5 - Address

Street Address Address Line 2 City Province Postal Code

Candidate 5 - Email

Candidate 5 - Phone Number

Candidate 5 - Parent Name

First Last

Candidate 5 - Is Parent a Senior DeMolay?

Yes

Candidate 5 - Is Parent a Mason?

Yes

Chapter Name & Location

Lodge Name, Number & Location

Candidate 5 - Parent Address

Street Address Address Line 2 City Province Postal Code

Candidate 5 - Parent Email

Candidate 5 - Parent Phone Number

Candidate 5 - Birth Date

Candidate 5 - Initiatory Degree Date

Candidate 5 - DeMolay Degree Date

Candidate 5 - First Line Signer

Candidate 5 - First Line Signer ID #

If unknown please mark UKN

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Form 10: Initiatory/DeMolay Degree Conferred

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