Elk Registration

Registration Information

Please complete all required fields for the Elk member registration.

First Name *

Last Name *

Phone Number *

Lodge *Select Lodge...Alexandria #758Arlington-Fairfax #2188Bedford-Lynchburg #321Charlottesville #389Clifton Forge #1065Danville #227Fredericksburg #875Front Royal #2382Hampton #366Harrisonburg #450Loudoun #2406Martinsville #1752Newport News #315Norfolk #38Onancock #1766Portsmouth-Chesapeake #82Pulaski #1067Richmond #45Roanoke #197Staunton #351Suffolk #685Virginia Beach #2268Waynesboro #2270Winchester #867Woodbridge #2355Other (Out of State)

Other Lodge Name & Number

Grand Lodge Officer? *Select...YesNo

Grand Lodge Officer TitleSelect Title...Grand Exalted RulerGrand Esteemed Leading KnightGrand Esteemed Loyal KnightGrand Esteemed Lecturing KnightGrand SecretaryGrand TreasurerGrand EsquireGrand ChaplainGrand Inner GuardGrand TilerGrand Membership & MarketingGrand TrusteeHoop Shoot Region 10 DirectorAD Drug AwarenessDDGERPGERPDDGER

State Officer? *Select...YesNo

State Officer TitleSelect Title...State PresidentState 1st VPState 2nd VPState 3rd VPState 4th VPState Secretary/TreasurerState ChaplainState TilerState Sergeant-At-ArmsState TrusteeState Presidential AideState PSPState Legal AdvisorState SponsorState VEYC PresidentState VEYC 1st VPState VEYC 2nd VPState VEYC 3rd VPState VEYC 4th VPState VEYC SecretaryState VEYC TreasurerState VEYC Trustee

Lodge Officer? *Select...YesNo

Lodge Officer TitleSelect Title...Exalted RulerEsteemed Leading KnightEsteemed Loyal KnightEsteemed Lecturing KnightSecretaryTreasurerTrusteeEsquireChaplainInner GuardTiler

Past Exalted Ruler? *Select...YesNo

Veteran? *Select...YesNo

Branch of MilitarySelect...ArmyNavyAir ForceMarinesCoast GuardSpace Force