OTHER MOOSE SITES
OSMA CONTACTS
Dwaine Brown
Regional Manager
John Sipes
OSMA Secretary
Steve Speaks
OSMA Webmaster
Jim Grandy
OSMA Publications
Report of Sickness and Distress
Please report Moose Sickness and Distress by completing this information form so that we can post it as soon as possible
Name of Member Sick or Deceased:
Is Above a Lodge or Chapter Member?
Select
Lodge Member
Chapter Member
Select Highest Degree Held if any:
Select
No Degrees
Moose Legion Member
Fellowship Degree
Pilgrim Degree
Academy of Friendship
Star Recorder
Green Cap
College of Regents
Lodge/Chapter
Name
Where Member:
Lodge/Chapter
Number
Where Member:
Please Provide Details of Distress Report:
Please Provide Information for Members to send Cards:
Mail Card to:
Name:
Address:
Address:
City:
State:
Zip:
If Death, Please Provide Funeral Details:
NOTICE:
A Death Notice
WILL NOT BE POSTED
without
complete information (Funeral Home,
Visitation, Funeral, etc).
If you do not have this information,
do not submit report
Date of Death:
Funeral Home Name:
Funeral Home Address:
Funeral Home City:
Funeral Home State
Funeral Home Zip:
Funeral Home Phone:
Visitation Details
Visitation Date(s)
Visitation Hours
Funeral Details
Funeral Date
Funeral Hours
Moose Service Details
Moose Service Date
Moose Service Time:
Please Provide Your Information
NOTE: NOTICE WILL NOT BE POSTED WITHOUT YOUR NAME AND A VALID EMAIL ADDRESS
My Name Is:
My E-Mail Address Is:
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MPORTANT NOTICE: The Loyal Order of Moose is a private organization. All activities and events referred to on this Web site and in the Moose newsletters published herein are available to members in good standing and their qualified guests only. This Web site is for informational purposes with proprietary information intended for members only. General information is available to the public at large, but should not be construed to be a solicitation for membership. This Web site is an initiative of the Ohio State Moose Association, and is not sanctioned by the Loyal Order of Moose, Moose International or any subsidiary thereof. All logos, trademarks and servicemarks pertaining to the Loyal Order of Moose and/or its programs or degrees are copyrighted © by Moose International, Inc., Mooseheart, Illinois.
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