Membership Card IL Membership Card Have Members complete this form to keep their benefits up to date.Please enable JavaScript in your browser to complete this form.Lodge Number *Members Full Name *Date of Birth *Cell Phone Number *Personnel Number (No department phones) Home Address *City, State, Zip *Email *Personnel Email (No department emails) Department Name *Beneficiary *Relationship to Member *Disclosure The State Lodge-sponsored Accidental Death & Disability policy is not valid without an identified beneficiary and member signature. Please submit a new card if your beneficiary information changes.Submit
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