COMMISSION ON SUBORDINATE LODGE SPECIAL ACTIVITIES Fundraiser Application

Lodge Name _________________________________________ Number _______ District _______ Date of Application: ___________________

Beginning Date of Project: Ending Date of Project: ___________________ ____________________Confirm what type of fundraiser will be held: Charity Non-Charity

Number of fundraisers your Lodge has already completed this year (if none, enter 0): ________�RAFFLE TYPE:

Gun Raffle General Raffle Golf Tournament BBQ Breakfast Dinner Food Sales - Other Merchandise Sales Other:_____________________

If this is a charitable fundraiser, please check all that apply: MHCO (Masonic Home for Children at Oxford)

WhiteStone: A Masonic & Eastern Star Community MESH, LLC (Masonic & Eastern Star Home, LLC)

NCMF (North Carolina Masonic Foundation) Other: _______________________________________

If this is a non-charitable fundraiser, please explain how this fundraiser will provide specific,

needed assistance to your Lodge Building Fund (planning for a new roof, need new HVAC system, etc.): _________________________________________________________________________

Describe your proposed fundraiser in detail. Make sure to explain what you are doing and

why this is a lodge fundraiser. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Name the location(s) where the fundraiser will be held: _____________________________________________________________________________________

(Over)

Before completing this application, read and familiarize yourself with BOTH Regulation 43-12 of "The CODE" and North Carolina General Statute § 14-309.15 concerning raffles. If there are any

questions, then consult with others as needed such as the Lodge Master, Lodge Secretary, DDGM, Grand Lodge Office, and/or the Subordinate Lodge Special Activities Commission PRIOR to

submitting this application to ensure the questions have been answered.

If a fundraiser includes multiple activities and one of those involves a raffle, then you must submit more than one fundraiser application — one for the raffle and a separate one for the non-raffle

activities. These cannot be combined into one application since proceeds from raffles must go to charities. Separate applications & separate final reports must be in order to clearly reflect which

funds were raised for which events and which entities benefited from which funds.

Page 1

INSURANCE

List the name of the insurance provider who provides your lodge’s LIABILITY coverage. If you insurance is through the Grand Lodge provider, then list “Anders, Ireland, and Marshall.”

**NOTE: Any lodge wishing to conduct a fundraiser must have liability coverage in order for the application to be approved. ________________________________________________________

By checking the box below, I attest that I have confirmed that my lodge has LIABILITY insurance coverage:

Completed by:__________________________________________ Title:________________________

Mailing Address: _____________________________________________________________________

City: , NC Zip: ___________________________________________________ ____________________

Phone Number: Email: _________________________________ ______________________________

Master’s Email Address: _______________________________________

Secretary’s Email Address: _____________________________________

Notes: 1) Before completing this application, read and familiarize yourself with BOTH Regulation 43-12 of "The CODE" and North Carolina General Statute § 14-309.15 concerning raffles. If there are any questions, then consult with others as needed such as the Lodge Master, Lodge Secretary, DDGM, Grand Lodge Office, and/or the Subordinate Lodge Special Activities Commission PRIOR to submitting this application to ensure the questions have been answered.

2) If a fundraiser includes multiple activities and one of those involves a raffle, then you mustsubmit more than one fundraiser application — one for the raffle and a separate one for thenon-raffle activities. These cannot be combined into one application since proceeds fromraffles must go to charities. Separate applications & separate final reports must be in order toclearly reflect which funds were raised for which events and which entities benefited fromwhich funds.

This form may be copied in order to have blank forms for future use. Rev. June 2020

Page 2