NYS Masonic Safety ID Program

NYS Masonic Safety ID Program

Event Registration Form

Event Name
Event Organization
Event Location

Name of School, Park, Lodge, Agency Building, etc.
Start Date / MM / DD YYYY
Start Time : HH : MM SS AM/PM
End Date / MM / DD YYYY
End Time : HH : MM SS AM/PM
Event Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

This address will be used by the public to map a location for the event
MSID Event Contact
Event Contact First Last
Contacts Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Please use a Street Address as UPS will not deliver to a P.O. Box
Contacts Email
Contacts Phone - (###) - ### ####
Alternate Phone - (###) - ### ####
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