Corporation of the Seven Wardens Camp #4: Iron Ring Replacement Form

Note: are indicate with a red outline. The information we ask for helps us eliminate any ambiguities and verify your obligation. If you're unsure of anything, make your best estimate; the Comments field is a good place to add explanatory information.

Some information about you.

Your First name(s) and Last name* (at the time you were obligated (e.g. what's on your Certificate)):

First (given) Name(s): Last (family) Name:


* (Note: 1/2 sizes are normally stocked. 1/4 sizes are available on special order up to size 2-1/4)

From which Camp did you originally receive your ring?
Obligation number (if available):


Where should we send the ring?

I would like to pick up my ring in person (check box)

Your email address: again: , Phone#:

(This form auto-fills these fields from your name at obligation. If your name for mailing is now different, please change it here.)
First Name(s): Last Name:

Your complete mailing address (select your Prov/State or International first):

Address 1: Address 2:

City: Postal Code: ZIP Code:
International Address:

*** Contact the Camp Secretary to arrange a meeting time. ***
*** Contact information is in the signature on your confirmation email. ***


Comments


(Note: This would be a good place to provide any information or explanation that would help us fulfill your request.)



Confirmation/Permission and Submit
  • I confirm that I am an obligated engineer, and also consent to the collection and use of the information I have provided in this form, in accordance with
    Kipling Camp #4's Privacy Policy), for the purpose of providing a ring replacement.
    or

    Note: After you submit this form, you will be taken to the "Replacement" page where you can make an electronic payment ($20 CDN). You should receive a confirmation email shortly.
    If either of these are missing, try again or contact the Camp Secretary