Motor Vehicle License Special Plate Request form
Motor Vehicle License Special Plate Request form
INSTRUCTIONS FOR FILING THE APPLICATION

  1. Complete Sections A & D only.
  2. Attach check payable to "Grand Lodge of Pennsylvania" for $25.00 (Include cost for additional registration cards, if desired.)
  3. DO NOT MAIL IT TO THE BUREAU OF MOTOR VEHICLES.
  4. Mail completed application, and check or money order to:
 
Grand Lodge of Pennsylvania
One North Broad Street
Philadelphia, PA 19107-2598
  1. The Grand Secretary's Office will validate your membership, complete sections B & C, and will forward it to the Bureau of Motor Vehicles.

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