CONTROL NUMBER ____________ (Office use only)
 
LOYAL ORDER OF MOOSE LIFETIME ACHIEVEMENT AWARD APPLICATION
 
Membership Information:
 
Enrollment Date - LOOM__________________ Moose Legion __________________
 
Enrollment Date - Fellowship_______________ Pilgrim _______________________
 
Council of Higher Degrees - Date ___________________ 25 Club ____________ Level_____________
 
Moose Legion of Honor ________________
 
PLEASE LIST AND BRIEFLY DESCRIBE YOUR INVOLVEMENT
IN THE FOLLOWING AREAS DURING YOUR ENTIRE LOOM MEMBERSHIP.
 
What is your greatest Moose accomplishment: Use additional paper if necessary.
 
______________________________________________________________________________________
 
__________________________________________________________________________________
 
Lodge Offices held:
_____________________________________________________________________________________
 
_____________________________________________________________________________________
 
District Offices held:
_____________________________________________________________________________________
 
 ____________________________________________________________________________________
 
  
State Offices held:
_____________________________________________________________________________________
 
_____________________________________________________________________________________
 
Regional Offices held:
_____________________________________________________________________________________
 
_____________________________________________________________________________________

 
 
 
CONTROL NUMBER ________________(Office use only)
 
 
Moose Legion Offices held:
_____________________________________________________________________________________
_____________________________________________________________________________________
 
Moose Charities - Check those that apply
 
Donors Circle ___ League of Guardians ___ Defending Circle Society ___ James J Davis ___
 
Committees Held:
Lodge: _______________________________________________________________________________
 
 
 
District:______________________________________________________________________________
 
 
State:________________________________________________________________________________
 
Moose Legion:_________________________________________________________________________
 
OTHER:
REFERENCES: ________________________________________________________________________
________________________________________________________________________
 
INTERVIEWED BY: ____________________________________________________________________
 
 
Mail completed form to:
 
Buster Skelton
Georgia Moose Association
62 Honey Lane
McDonough, Ga 30252
 
Deadline: SEPTEMBER 27, 2017