F
ORM 133
05/17
Establish A New Council
TO: Membership Development Department
FROM: State Deputy
Jurisdiction
District Deputy of District No.
has been directed to explore the possibility of working in
.
e membership for this council will be drawn from the following parish(es) in the area:
Anticipated Finish Date:
Reinstitute Council # Reactivate Council #
English French
Spanish Polish
Signed
Mail Copies To: State NCD Chairman
District Deputy
Mail Original To: State Deputy
en Supreme Oce
STATE DEPUTY
NAME
CITY OR TOWN
DATE
NOTICE OF INTENT
Please send a Canvasser’s Kit to:
Name
Street Address:
City: State or Province: Zip:
Please select language:
Date Needed By:
Kits are provided at no charge — Shipping costs will be charged to the State Council if kits need to be
rushed.