EmailMe Form - 2017 Potentate Visitation Request

2017 Potentate Visitation Request

Kevin Hall, Potentate Elect is planning his calendar for 2017. If you would like to request a special visit or schedule an "Official Visit" with the Divan included, please utilize this request form. Review the online calendar for any conflicts. All the potentate's meetings and visitations are in RED.

All * fields are required. Data will be submitted to Chief Rabban and his Chief Aide. Once confirmed, you will receive an email confirmation and the date will be added to the calendar. Again, all fields must be filled in.

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Club, Unit or Organization Name *
Shrine Club, Shrine Unit or Other Organization
Contact Name *
First Last
Contact's Email *

Confirm Email
Phone (include Area Code) *
### - ### - ####
Suggested Dates. Please suggest two possible dates for the visit and we will confirm via email.
First Suggested Date *
MM / DD / YYYY
Second Suggested Date *
MM / DD / YYYY
Time to Arrive *
HH : MM AM/PM
What time do you want the potentate to arrive?
Time The Events Starts? *
HH : MM AM/PM
Actual start of the event.
Address of Event *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Physical address of event.
Type of Event.
Stated Meeting, Installation
of Officers,Fund Raiser, Public Information address, etc *
Dress Code Attire:
casual, suit & tie, formal. *
Is there a meal served? *
Are Ladies welcome at
this event? *
Do you want the Divan officers and other appointees included? *
Additional comments that need to be known to all attending.
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Suggested Dates. Please suggest two possible dates for the visit and we will confirm via email.