Payments & Donations Brother (Name)* First Last Lodge Phone*Email* District DuesAnnual Dues Quantity Price: $25.00 Quantity Purple Circle (for two years) Quantity Price: $20.00 Quantity Name(s) of Brother(s) paid forHelping others this holiday Season ... Quantity Price: $0.00 Quantity Suggested donation $10 (the cost of a Thanksgiving meal) General DonationDonation Amount Where would you like the donation applied? (optional) PaymentTotal $0.00 Credit Card Card Details Cardholder Name
