Request for Dispensation

Today's Date(Required)

Dispensation request to the:(Required)

M.E. Grand High Priest of the Grand Chapter of Royal Arch Masons of Florida

M.I. Grand Illustrious Master of the Grand Council of Royal and Select Masters of Florida

R.E. Grand Commander of the Grand Commandery of Knights Templar of Florida

Name of York Rite Body(Required)

York Rite Body Type(Required)

York Rite Body Number(Required)

We respectfully request dispensation to:(Required)

Date for the Dispensation(Required)

Time(Required)

Name of Presiding Officer(Required)

Prefix First Middle Last Suffix

Title(Required)

Secretary/Recorder's Name(Required)

Prefix First Middle Last Suffix

Secretary/Recorder's Email(Required)

Enter Email Confirm Email

Secretary/Recorder's Address(Required)

Street Address Address Line 2 City State ZIP Code

Upload York Rite Body Seal Image(Required)

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