^{PO Box 383 - 520 Easton Road, Riegelsville PA 18077}

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Conditions of Rental

REQUEST FOR RENTAL OF PROSPERITY LODGE NO. 567 - SOCIAL HALL

Company/Organization: 

Name: 

Address: 

City,  State  Zip: 

Phone Numbers -

Home:   Work:    Cell: 

E-Mail Address: 

 

Rental Date(s) Requested:

From...                        To...

(ex: 05/15/2005 5:00PM  to 05/15/2005 11:00pm)

1.   

2.   

3.   

4.   

 

 

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