Sickness & Distress

 

Please use the following form to notify Vegas Lodge No. 32 of any instances of Sickness or Distress you feel we should know about. Please provide us with suitable contact information should we need to get a hold of your for any clarifications. Thank you!

Your Name: 
Your E-mail: 
Your Phone Number:
Name of Individual under  
Sickness or Distress:
Description of Sickness or Distress:

Thank you for your time and thoughtfulness in helping alert us about the potential need of this individual.