Form 10

Chapters must submit a Form 10 within 10 days of a member's Initiatory Degree or Vow Ceremony, DeMolay Degree, or notification of a change of address or status. List dates degrees or ceremonies received. Unless waived under a special program, fees of $35.00 to Oregon DeMolay are due for each new member with their Initiatory Degree or Vow Ceremony report. From this, Oregon DeMolay will forward $25.00 to DeMolay International. No fees are due for address changes, status changes or DeMolay Degree reports. There is space on this electronic form to input information for two members.

Chapter Name

Chap. #

Location City ,

Oregon

Member 1
Name			Birth Date
			Init. Date
			DeM. Date
Address			Phone
			E-mail
	First Line Signer Name ID #	Status change *EO approval required	Status Date	Member ID # for Status Change
Parent's Name			Father a Senior DeMolay? Yes No
Parent's Address			Parent Phone
			Parent Email

Member 2
Name			Birth Date
			Init. Date
			DeM. Date
Address			Phone
			E-mail
	First Line Signer Name ID #	Status change *EO approval required	Status Date	Member ID # for Status Change
Parent's Name			Father a Senior DeMolay? Yes No
Parent's Address			Parent Phone
			Parent Email

Payment method (check one)	Mailing separate check--mail with copy of confirmation VISA/MC Exp. Date (MM/YYYY) Name on card Note: Card transactions will be processed separately. This form does not initiate a transaction. Special promotion. No fee due from member or chapter.
Mail Patents to (Name, Address, comments)
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