K of C Council 10311 Registration Application

Please fill in the appropriate blanks below.  

Be as complete as possible and enter NA for non-applicable blanks.  Click on 'submit' button when complete

Click on appropriate buttons/check boxes as necessary

Date:   

First Name

Last Name

Middle Initial

Rank or Title

Street

City

State

Zip Code

E-Mail Address

Area Code Telephone Number

Date  of Birth 

(MM/DD/YYYY)
Marital Status

Married

Single

No. Years at above address

 

Occupation

Social Security Number

Employer

KofC Insurance Certificate Numbers
Former Columbian Squire?

 Yes  

No

Are you a practical Catholic in communion with the Holy See?

Yes

No

Name of Parish

Did you apply for membership previously?

Yes

No

Degrees Received

& Dates

1st Degree

(MM/DD/YYYY)

2nd Degree

(MM/DD/YYYY)

3rd Degree

(MM/DD/YYYY)

4th Degree

(MM/DD/YYYY)
Baptized
Confirmed?

 

Number of Last Council

 

Location

Date  of Termination 

(MM/DD/YYYY)

Reason For Leaving

Comments?

A Knight from our council should contact you within several weeks