STATE CONVENTION IN MEMORIAM FORM

The following is the list of members of this Council who died in the period April 1, 2022 to April 1, 2023. We ask that you include in this list in the report being prepared for the 124th Ohio State Council Convention.

Please identify any of the following as Clergy, Charter Members, or Former Officers. Indicate in each instance the highest office held.

Council Number *

Your First and Last Name *

Your Phone Number *

Your Email Address *

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	Name of Deceased	Highest Title Obtained (If Any)	Date of Death (If Known)
1	Name of Deceased	Highest Title Obtained (If Any)	Date of Death (If Known)
2	Name of Deceased	Highest Title Obtained (If Any)	Date of Death (If Known)
3	Name of Deceased	Highest Title Obtained (If Any)	Date of Death (If Known)
4	Name of Deceased	Highest Title Obtained (If Any)	Date of Death (If Known)
5	Name of Deceased	Highest Title Obtained (If Any)	Date of Death (If Known)
6	Name of Deceased	Highest Title Obtained (If Any)	Date of Death (If Known)
7	Name of Deceased	Highest Title Obtained (If Any)	Date of Death (If Known)
8	Name of Deceased	Highest Title Obtained (If Any)	Date of Death (If Known)
9	Name of Deceased	Highest Title Obtained (If Any)	Date of Death (If Known)
10	Name of Deceased	Highest Title Obtained (If Any)	Date of Death (If Known)