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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.
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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
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