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 forGeneral DonationDonation Amount Where would you like the donation applied? (optional) PaymentTotal $0.00 Credit Card Card Details Cardholder Name
