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 home : resources : form10 :

Online Form 10 Submission


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You can submit and pay for a Form 10 Online. The cost is $35 per new member submitted. The Georgia DeMolay Online Form 10 Submission Tool is only intended for the use of Advisors associated with a DeMolay Chapter in the state of Georgia, and not for the DeMolay community at large. You can process up to five new members per transaction. Additional new members must be processed in another transaction.

If you have members receiving only the DeMolay Degree who were previously reported and paid on another Form 10 after receiving the Initiatory Degree, please use the Form 10-D. There is no charge for reporting a DeMolay Degree date on a Form 10-D.

Related Forms

Please Note: * indicates a required field

Chapter Information

Chapter Name/ID/Location:

*

Advisor ID Number:

Advisor Full Name:

*

Advisor Address:

*

Advisor Address 2:

Advisor City:

*

Advisor State:

*

Advisor ZIP Code:

*

Advisor Phone:

xxx-xxx-xxxx

Advisor E-Mail:

*

 

Please ensure that your e-mail address is correct.
A confirmation of your transaction will be sent to this e-mail address.

New Member #1 Information

Last Name:

*

First Name:

*

Middle Name:

Address:

*

Address 2:

City:

*

State:

*

ZIP Code:

*

Home Phone:

xxx-xxx-xxxx

Other Phone:

xxx-xxx-xxxx

E-Mail:

Date of Birth:

* mm/dd/yyyy

Initiatory Degree Date:

* mm/dd/yyyy

DeMolay Degree Date:

mm/dd/yyyy

 

First Line Signer ID Number:

First Line Signer Full Name:

*

 

Parent Last Name:

*

Parent First Name:

*

Parent Address:

*

Parent Address 2:

Parent City:

*

Parent State:

*

Parent ZIP Code:

*

Parent Home Phone:

xxx-xxx-xxxx

Father Sr. DeMolay?

Father Mason?

New Member #2 Information

Last Name:

*

First Name:

*

Middle Name:

Address:

*

Address 2:

City:

*

State:

*

ZIP Code:

*

Home Phone:

xxx-xxx-xxxx

Other Phone:

xxx-xxx-xxxx

E-Mail:

Date of Birth:

* mm/dd/yyyy

Initiatory Degree Date:

* mm/dd/yyyy

DeMolay Degree Date:

mm/dd/yyyy

 

First Line Signer ID Number:

First Line Signer Full Name:

*

 

Parent Last Name:

*

Parent First Name:

*

Parent Address:

*

Parent Address 2:

Parent City:

*

Parent State:

*

Parent ZIP Code:

*

Parent Home Phone:

xxx-xxx-xxxx

Father Sr. DeMolay?

Father Mason?

New Member #3 Information

Last Name:

*

First Name:

*

Middle Name:

Address:

*

Address 2:

City:

*

State:

*

ZIP Code:

*

Home Phone:

xxx-xxx-xxxx

Other Phone:

xxx-xxx-xxxx

E-Mail:

Date of Birth:

* mm/dd/yyyy

Initiatory Degree Date:

* mm/dd/yyyy

DeMolay Degree Date:

mm/dd/yyyy

 

First Line Signer ID Number:

First Line Signer Full Name:

*

 

Parent Last Name:

*

Parent First Name:

*

Parent Address:

*

Parent Address 2:

Parent City:

*

Parent State:

*

Parent ZIP Code:

*

Parent Home Phone:

xxx-xxx-xxxx

Father Sr. DeMolay?

Father Mason?

New Member #4 Information

Last Name:

*

First Name:

*

Middle Name:

Address:

*

Address 2:

City:

*

State:

*

ZIP Code:

*

Home Phone:

xxx-xxx-xxxx

Other Phone:

xxx-xxx-xxxx

E-Mail:

Date of Birth:

* mm/dd/yyyy

Initiatory Degree Date:

* mm/dd/yyyy

DeMolay Degree Date:

mm/dd/yyyy

 

First Line Signer ID Number:

First Line Signer Full Name:

*

 

Parent Last Name:

*

Parent First Name:

*

Parent Address:

*

Parent Address 2:

Parent City:

*

Parent State:

*

Parent ZIP Code:

*

Parent Home Phone:

xxx-xxx-xxxx

Father Sr. DeMolay?

Father Mason?

New Member #5 Information

Last Name:

*

First Name:

*

Middle Name:

Address:

*

Address 2:

City:

*

State:

*

ZIP Code:

*

Home Phone:

xxx-xxx-xxxx

Other Phone:

xxx-xxx-xxxx

E-Mail:

Date of Birth:

* mm/dd/yyyy

Initiatory Degree Date:

* mm/dd/yyyy

DeMolay Degree Date:

mm/dd/yyyy

 

First Line Signer ID Number:

First Line Signer Full Name:

*

 

Parent Last Name:

*

Parent First Name:

*

Parent Address:

*

Parent Address 2:

Parent City:

*

Parent State:

*

Parent ZIP Code:

*

Parent Home Phone:

xxx-xxx-xxxx

Father Sr. DeMolay?

Father Mason?

When you press continue, your order will be summarized and the total amount due will be calculated. Fees for submitting a Form 10 are $35 per new member.

 Online Form 10 Submission
 http://gademolay.org/resources/form10/index.html

Last Modified: 6 November 2013 
Copyright © 2014, Georgia DeMolay