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Primary Contact
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First
Last
Time Zip Contact
Contact's Phone Number
Phone Number of the Primary Contact
Council
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— Select Choice —
4970
11724
15693
Who is hosting the Exemplification?
Type of Exemplification
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Charity/Unity/Fraternity
4th Degree/Patriotism
Instructions
Please let the sponsors know any specific instructions.
Date and Time
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yyyy/mm/dd hh:mm
Church
If the Exemplification will be at a church, what is the name of the church
Street Address
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City
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Venue Zip Code
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