The Lapel Team Call Out Request Form

The Lapel Team Call Out is a special 3 minute ceremony done at wakes for members of the 3rd and 4th degree in good standing as a final farewell to the deceased member. During the ceremony a Lapel Pin is attached to the member’s suit jacket on the left side after approval is given by the closest family member to the deceased. This request is to be only submitted by the Assembly Commander or Navigator where the deceased was a Member. The Assembly Commander or Navigator must secure permission from the family prior to submitting this request.

Assembly Commander Name:

Assembly Commander Email:

Assembly Commander Phone #:

Assembly No:

Immediate Family Member Approving Lapel Pin Ceremony:

Lapel Pin:

--------------------------------------------------------
Deceased Name:

Funeral Home:

Funeral Address:

Funeral Date:

Funeral Time:

--------------------------------------------------------
Notes for Lapel Team: (Optional)

Enter the Recaptcha Code from the image on the right in the box below before clicking submit. If you are receiving an error that you cannot continue try to refresh the Recaptcha code by clicking Change Image and enter the new one that comes up and click Submit.

Recaptcha CAPTCHA Image Change Image

Please wait about 30 seconds to 1 minutes after clicking the submit button for the email to be sent. Please make sure to wait for the email to come to you and could be up to 2 to 5 minutes. This will ensure your callout request has been emailed out correctly.