This form must be submitted to Northern California DeMolay within ten (10) days following the Installation of Officers.

Chapter Name: Installation Date:

Person submitting this form: Your E-Mail:

Master Councilor
Name: R.D.? L.C.C.?

Address: D.L.C.?

City: Zip: Phone:

Birthdate: E-Mail Address:

Senior Councilor
Name: R.D.? L.C.C.?

Address: D.L.C.?

City: Zip: Phone:

Birthdate: E-Mail Address:

Junior Councilor
Name: R.D.? L.C.C.?

Address: D.L.C.?

City: Zip: Phone:

Birthdate: E-Mail Address:

Chapter Advisor
Name: L.C.C.?

Address: Phone:

City: Zip: Work Phone:

Birthdate: E-Mail Address:

Chapter Information
Chapter Meeting Nights: Month of Next Installation:

Sponsoring Body:

Advisory Council Chairman
Name: L.C.C.?

Address: Phone:

City: Zip: Work Phone:

Birthdate: E-Mail Address:

Parents Club:
Name: L.C.C.?

Address: Phone:

City: Zip:

Birthdate: E-Mail Address:

Sweetheart
Name: L.C.C.?

Address: Phone:

City: Zip: Pink Honor Key?:

Birthdate: E-Mail Address:

Senior Princess
Name: L.C.C.?

Address: Phone:

City: Zip: Pink Honor Key?:

Birthdate: E-Mail Address:

Junior Princess
Name: L.C.C.?

Address: Phone:

City: Zip: Pink Honor Key?:

Birthdate: E-Mail Address: