IYD Data Collection Form [vr. 1.00]

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This form is used to collect information on Youth Groups across the Domain. For assistance, contact one of the Chief Deputies: Daughters contact Dt. Lorraine James - 850-212-0054 and Nobles contact Noble John Buckley - 330-780-9963.

Temple/Court Name and Number *

City, State *

Number of youth served.
*

Director/Directress Name (Last name, First name)
*

Phone Number
*

Email Address

Illustrious Potentate/Commandress Name (Last name, First name)
*

Potentate/Commandress Phone number (Format: ###-###-####)
*

Potentate/Commandress Email
*

Deputy of/for the Desert Name
*

Desert Deputy Phone number (Format: ###-###-####)
*

Desert Deputy Email
*

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