Most Worshipful Prince Hall Grand Lodge of Illinois

1 most Worshipful Prince hall Grand Lodge of Illinois Unification 2015 ~ July 30 - August 6, 2015 Hilton Springfield * 700 East Adams Street * Springfield, IL 62701 Registration Form Please complete this form to register for the 2015 Unification Session. Your registration includes a meal selection for the 2015 Unification Banquet as well as a gift package from the MWPHGL of Illinois . Please mail your payment to: most Worshipful Prince hall Grand Lodge of Illinois 809 East 42nd Place Chicago, Illinois 60653 DO NOT SEND CASH IN THE MAIL. Please make all checks or money orders made payable to "MWPHGL of Illinois ". Register by June 30, 2015 to receive Early-Bird discounts. Only CERTIFIED FUNDS will be accepted after June 30, 2015. Please be advised that a $ fee will be assessed for returned checks. NO REFUNDS after Saturday, July 18, 2015. NOTE: Registration for Elected Grand Lodge Officers, Past Grand Masters and current Heads of Houses will be prepared and processed directly by the 2015 Unification Registration Committee.

2 Full Name: SEX (circle one): Male Female Name and Number of Lodge /Chapter/Court/Etc.: Address: City: State: Zip: Phone: Alternate Phone: Email: Highest Office Held: Registration Options: Early Bird After (6/30/2015) Amount Past Head of House (ACTUAL OR HONORARY) $ $_____ Voting Member $ $ $_____ $ $ $_____ Non-Voting Member Extra Banquet Tickets Quantity: _____ x $ $_____ TOTAL $ Please check the Session(s) that you will attend below: most Worshipful Prince hall Grand Lodge of Illinois Eureka Grand Chapter Order of the Eastern Star most Excellent Prince hall Grand Chapter Holy Royal Arch Masons most Ancient Prince hall Grand Court Heroines of Jericho most Illustrious Prince hall Grand Council Royal & Select Masters Levi H.

3 Morris Grand Court Ladies of the Circle of Perfection Prince hall Grand Commandery Knights Templar Prince hall Grand Guild Heroines of the Templar Crusades John W. Thompson Priory #3 Knights of the York Cross of Honor Levi L. Rose Priorate #1 Princess of the York Cross of Honor Meal Selection (Enter the Quantity in the space provided for your meal selection): Beef _____ Chicken _____ Fish _____ Vegetable _____ most Worshipful Prince hall Grand Lodge of Illinois Unification 2015 ~ July 30 - August 6, 2015 Hilton Springfield * 700 East Adams Street * Springfield, IL 62701 Souvenir Ad Book Form Please complete this form to place an advertisement in the 6 x 9 , full color Souvenir Book for the 2015 Unification Session and mail along with your payment to: most Worshipful Prince hall Grand Lodge of Illinois 809 East 42nd Place Chicago, Illinois 60653 DO NOT SEND CASH IN THE MAIL.

4 Please make all checks or money orders made payable to "MWPHGL of Illinois ". Full Name: SEX (circle one): Male Female Name and Number of Lodge /Chapter/Court/Etc.: Address: City: State: Zip: Phone: Alternate Phone: Email: Souvenir Ad Book Options: Quantity Early Bird After (6/30/2015) Amount Outside Rear Cover $ $ Inside Front Cover $ $ Inside Rear Cover $ $ Full Page Ad $ $ Half Page Ad $ $ Quarter Page Ad $ $ Business Card $ $ TOTAL Please add greetings in the space below or attach additional pages if necessary: You may also email your photo or advertisement directly to All ads are due by Saturday, July 11, 2015. Right Worshipful Brother Daryl L. Andrews, Souvenir Book Chairman Right Worshipful Brother Sean Queen, Grand Secretary most Worshipful Brother Millard V.

5 Driskell, Grand Master