4th Degree Candidates And Guests Exemplification Form

FORM IS ONLY TO BE FILLED OUT BY A FAITHFUL NAVIGATOR OR FAITHFUL COMPTROLLER

Assembly Name:

Contact Name:

E-Mail:

ONLY ONE NAME PER LINE (Example: John Smith NOT Mr. & Mrs. Smith)

1. Title:	Name:	Type:
2. Title:	Name:	Type:
3. Title:	Name:	Type:
4. Title:	Name:	Type:
5. Title:	Name:	Type:
6. Title:	Name:	Type:
7. Title:	Name:	Type:
8. Title:	Name:	Type:
9. Title:	Name:	Type:
10. Title:	Name:	Type:

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 4th Degree Candidates And Guests Exemplification Form is submitted correctly.

If you have more than 10 names you can submit additional names once the form goes blank. Once the forms does you will fill out the Assembly, your Contact Name, and Email Address and then continue with the next set of names on your list.