MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
WARDEN
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
ADVOCATE
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
TREASURER
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
MEMBERSHIP NO. LAST NAME FIRST NAME I
NITIAL EMAIL
RECORDER
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
MEMBERSHIP NO. LAST NAME FIRST NAME I
NITIAL EMAIL
CHANCELLOR
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
DEPUTY
MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
GRAND KNIGHT
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
185 3/11
Due By:
JUNE 30, 20__
COUNCIL ADDRESS (Meeting Location)
STREET ADDITIONAL ADDRESS
CITY ST/PROV. ZIP/POSTAL CODE
Council #____________ DATE OF ELECTION____________________
MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
INSIDE GUARD
MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
OUTSIDE GUARD
TRUSTEE FOR
MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
ONE YEAR
TRUSTEE FOR
MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
TWO YEARS
TRUSTEE FOR
MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
THREE YEARS
COUNCIL MEETS
____________________________________________________________________________________
SIGNED F.S.
• THIS INFORMATION IS ESSENTIAL FOR TRANSACTION OF OFFICIAL BUSINESS AND DIRECT MAIL COMMUNICATIONS WITH OFFICERS.
• APPOINTMENT OF FINANCIAL SECRETARY. (SECTION 128, LAWS AND RULES).
THE FINANCIAL SECRETARY SHALL BE APPOINTED BY THE SUPREME KNIGHT. HE SHALL HOLD OFFICE AT THE WILL OF THE SUPREME KNIGHT.
MAIL ORIGINAL TO: Membership Records MAIL COPIES TO: State Deputy, District Deputy, Council File
PLEASE PRINT — INDICATE MEMBERSHIP NUMBERS
REPORT OF OFFICERS CHOSEN FOR THE TERM
JULY 1, 20__ TO JUNE 30, 20__
MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL
GRAND KNIGHT
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
TELEPHONE
NEWLY ELECTED RE-ELECTED A
REA CODE PHONE NO. EMAIL:
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