District Dues and Assessment Payment Form - GRAND UNITED ORDER OF ODD FELLOWS IN AMERICA AND JURISDICTION

District Dues and Assessment Payment Form

Name(Required)

First Last

Email(Required)

Age(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Lodge Name(Required)

District Dues Fee

The district dues fee includes a processing fee.

Assessment Fee

Please enter your assessment fee here.

Assessment Fee Details

Reason for Assessment Fee

Total

Credit Card

Card Details

Cardholder Name