Far North Lodge #199, A.F.&A.M., G.R.A.
CONSECRATION
July 1 to 4, 2004
Inuvik, Northwest Territories
REGISTRATION FORM
CONSECRATION DELEGATE INFORMATION
Delegate Name :
Grand Lodge or Lodge Name / Number:
Masonic Rank (ie MW, VW)
Home Address
City:
Prov / Terr / State
Postal / Zip Code
Telephone :
FAX :
Email:
TRAVEL INFORMATION
Traveling to Inuvik by:
Alberta/ NWT Charter Air
Yukon Charter Air (Please contact Bro. Tom Mickey)
Dempster Highway
Own Arrangements
Expected Date of Arrival
ACCOMMODATION INFORMATION
Staying At:
Mackenzie Delta Hotel Group
Preferences: Type Smoking Non-Smoking Beds One Bed Two Beds
Campground
Power: Not Applicable Required Not Required
Sewage Hookup: Not Applicable Required Not Required
Making Own Arrangements
(Adults) 0 1 2 3 4 (Children) 0 1 2 3 4
Guest Names:
1. (Delegate)2. (Guest 1)3. (Guest 2)4. (Guest 3)
PAYMENT INFORMATION
Alberta Charter
Hotel(3 Nights)
Consecration Ceremony
Banquet / Dance Only
Campground Package*
Delegate
Guest 1
Guest 2
Guest 3
Total Booked
0 1 2 3 4
Cost Each
$395
$250
$150
$100
$225
After April 1 From Edmonton
$550
From Calgary
$650
Total Cost
0 $550 $650 $1100 $1300
0 $250 $500 $750 $1000
0 $150 $300 $450 $600
0 $100 $200 $300 $400
0 $225 $450
Total Due: $
*Note: Only 1 required per RV or Campsite. This includes one delegate registration, one banquet / dance and the campground fees.
Deposit of 50% must accompany form. Final Payment due April 1, 2004
Please charge to my credit card:
Type VISA Mastercard Expiry Date: Month 01 02 03 04 05 06 07 08 09 10 11 12 / Year 2003 2004 2005 2006 2007 2008 2009 2010
Amount to Charge:
Full Amount Deposit Only (50% of total)
If "Deposit Only" selected, remainder will be charged to the above card number on April 1, 2004
Cheque / Money Order enclosed (Make payable to “Far North Lodge Consecration”)