Elks Medal of Valor Awarded

Lodge Name

Lodge Contact Name

Lodge Contact Email

Number of Members Attending

Session Attending

Florissant (April 20, 2025, 9am-3pm)Blue Springs (April 27, 2025, 9am-3pm)

Your lodge name

Your lodge number

Your membership number

Your name

Your spouse's name

Your email

Your mobile phone

Your work phone

Your home phone

Your address

City

State

Zip

Highest office held:

G.L. Office/CommitteeDDGERSp. DeputyState PresidentState OfficerE.R./P.E.R.Member

NOTE: To the best of our ability, you will be assigned to the committee that we feel can best utilize your
skills. If you have a committee preference(s), please check below:

Airport GreetersCommunicationsInformation BoothLegislative AssistantsManpowerMedia RelationsMusic & EntertainmentRegistration ControlRitualisticTransportationUshersVIP Room