STATUS *

DIOCESE *

ORIGINATOR'S FULL NAME (FIRST AND LAST) *

ORIGINATOR'S EMAIL ADDRESS *

FS Completed? *

FS SIGN DATE * +

ENTER FS EMAIL ADDRESS

GK Completed? *

GK SIGN DATE * +

ENTER GK EMAIL ADDRESS

Membership in the Knights of Columbus is open to men 18 years of age or older who are practical (that is; practicing) Catholics in union with the Holy See. This means that an applicant or member accepts the teaching authority of the Catholic Church on matters of faith and morals, aspires to live in accord with the precepts of the Catholic Church, and is in good standing in the Catholic Church.

NEW/RECEIVING COUNCIL NUMBER

LOCATION (CITY, ST/PROV)

MEMBERSHIP NUMBER

DATE READ +

DATE ELECTED +

EXEMP DATE +

PREFERRED LANGUAGE *

ENGLISH

SPANISH

DATE OF DEATH +

PROVIDE SURVIVOR'S INFORMATION BELOW

NEXT OF KIN

RELATIONSHIP

TELEPHONE

STREET

CITY

STATE

POSTAL CODE

LAST NAME *

FIRST NAME *

MIDDLE INITIAL

TITLE

STREET *

CITY *

STATE

POSTAL CODE *

COUNTRY (OUTSIDE US)

DATE OF BIRTH +

MARITAL STATUS

HOME PHONE

BUSINESS PHONE

CELL PHONE

EMAIL ADDRESS

OCCUPATION/EMPLOYER

LAST 4-DIGITS OF TAX ID

ARE YOU A PRACTICAL OR PRACTICING CATHOLIC IN UNION WITH THE HOLY SEE?

YES

PARISH NAME, LOCATION (CITY, ST/PROV)

FORMER COLUMBIAN SQUIRE?

YES

DID YOU APPLY FOR MEMBERSHIP PREVIOUSLY?

YES

DATE OF BIRTH +

INITIATION DATES

1. FIRST +

2. SECOND +

3. THIRD +

4. FOURTH +

DATE OF TERMINATION +

REASON

NUMBER OF LAST COUNCIL

LAST COUNCIL LOCATION (CITY, ST/PROV)

I HEREBY RECOMMEND THE ABOVE APPLICANT FOR MEMBERSHIP:

PRINTED NAME OF PROPOSER

PROPOSER'S MEMBERSHIP NUMBER

USE YOUR FINGER, MOUSE, OR STYLUS TO SIGN BELOW

SIGNATURE OF APPLICANT *

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SIGNATURE OF FINANCIAL SECRETARY

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SIGNATURE OF GRAND KNIGHT

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NEW MEMBER	JUVENILE TO ADULT
REINSTATEMENT (up to 3 months)	REACTIVATION (inactive insurance)
READMISSION (up to 7 years)	REAPPLICATION (over 7 years)
TRANSFER IN	DATA CHANGE
SUSPENSION	DEATH