Forms | Member Owned | Western Fraternal Life


Member Service Forms

Change your Beneficiary
Change your Name
Change your Owner
Change your Address
Set up Electronic Funds Transfer for Automatic Premium Payments
Change your automatic loan payment

Return completed form to the Home Office by mail: C/O Member Service,Western Fraternal Life,1900 First Avenue NE, Cedar Rapids, Iowa 52402 or email or fax: 319.363.8806 or call: 1-877-935-2467 or 319-363-2653 to talk to someone in our Member Service Department.

Lodge Forms

Annual Survey of Lodge Activities
Lodge Officer Report
Lodge Points Activity Form - Online
Use the online activity form OR the printable form, whichever format you prefer.

Lodge Points Activity Form - Printable
You can use these online forms to submit your points activities. Click here for the activity form, click here for the monetary donation form, and click here for the points descriptions.

Question and Answer for Points System

Fraternal Herald Forms

Lodge Article Form
Kitchen Talk form submit a cook
Kitchen Talk recipe submission
Lodge Obituary form
Calendar of Events Form

Publicity Forms

Media Kit Guidelines
Publicity Training
Sample Press Release 

State and District Meetings

State and District Officer Election Forms
State and District Meeting Mileage/Attendance Form
State and District Meeting Article Guidelines and Form

Miscellaneous Forms

Fraternalist of the Year Guidelines
Graduating Member Form
Lodge Material Price List
Members in Action pre-event form
Members In Action post event form

Outstanding Individual Award Certificate form
Referral Form

Donation form
Member Matching Funds
Community Matching Funds
National Scholarship Application Form

Item GiveAway Registration Slips
Item Giveaway Pre-approval form


Do you have questions about Western or about your certificate? Our member service department is available from 7:45 a.m. to 4:30 p.m. CST, Monday to Thursday and 7:45 a.m. to 1:15 p.m. on Fridays. Our helpful member service representatives are happy to answer any of your questions. We are committed to protecting your privacy and our member service representatives follow Western privacy policies when dealing with your personal information.


Call 877-935-2467 to speak with a Western Fraternal Life Representative.