Most Worshipful Prince Hall Grand Lodge, F.&A.M. PHA
Jurisdiction of Oklahoma
P.O. BOX 2348
MUSKOGEE, OK 74402-2348

ANNUAL ELECTION OF OFFICERS FORM

LODGE NAME/NO. _______________________________________________________ DISTRICT______

LODGE LOCATION/ADDRESS_____________________________________________________________

LODGE MAILING ADDRESS ______________________________________________________________
(if different than WM/SEC)
_________________________________________________________________________________________
LODGE EMAIL ADDRESS  ________________________________________________________________

WORSHIPFUL MASTER___________________________  SECRETARY__________________________________

ADDRESS________________________________________  ADDRESS_____________________________________

CITY/STATE/ZIP_________________________________  CITY/STATE/ZIP_______________________________

TELEPHONE_____________________________________  TELEPHONE__________________________________

E-MAIL:__________________________________________  E-MAIL	        __________________________________
DEROS:_______________ 				          DEROS:__________________

SENIOR WARDEN________________________________  TREASURER__________________________________

ADDRESS________________________________________  ADDRESS_____________________________________

CITY/STATE/ZIP_________________________________  CITY/STATE/ZIP_______________________________

TELEPHONE_____________________________________  TELEPHONE__________________________________

EMAIL:__________________________________________  EMAIL:_______________________________________
DEROS:___________________			         DEROS:_____________________

JUNIOR WARDEN________________________________  FINANCIAL SECRETARY______________________

ADDRESS________________________________________  ADDRESS_____________________________________

CITY/STATE/ZIP_________________________________  CITY/STATE/ZIP______________________________

TELEPHONE_____________________________________  TELEPHONE_________________________________
EMAIL:__________________________________________  EMAIL ______________________________________
DEROS____________________			         DEROS:___________________

DATE SIGNED 	______________________

_____________________________________________ 			_________________________________________
WORSHIPFUL MASTER SIGNATURE					SECRETARY SIGNATURE
_________________________________________________ 			_____________________________________________
PRINTED/TYPED NAME						PRINTED/TYPED NAME
SEAL												                JUN 07
COMPLETE AND RETURN IMMEDIATELY AFTER ELECTIONS EACH YEAR