WARDEN MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
ADVOCATE MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
TREASURER MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
RECORDER MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□
ADDRESS CHANGE
CHANCELLOR MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□
ADDRESS CHANGE
D
EPUTY
MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
GRAND KNIGHT
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
COUNCIL ADDRESS (Meeting Location)
STREET ADDITIONAL ADDRESS
CITY ST/PROV. ZIP/POSTAL CODE
INSIDE GUARD MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
OUTSIDE GUARD MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
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.
SEND ORIGINAL TO: Membership Records (email: AddressChange@kofc.org)
SEND COPIES TO: State Deputy, District Deputy, Council File
G
RAND KNIGHT MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
TELEPHONE
NEWLY ELECTED RE-ELECTED AREA CODE PHONE NO. EMAIL:
LECTURER MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
CHAPLAIN MEMBERSHIP NO. LAST NAME FIRST NAME INITIAL EMAIL
STREET CITY STATE/PROVINCE ZIP/POSTAL CODE
□ ADDRESS CHANGE
185 4/18
Due By:
JUNE 30
T
HIS REPORT CAN BE COMPLETED USING MEMBER MANAGEMENT.
OTHERWISE PLEASE PRINT — INDICATE MEMBERSHIP NUMBERS
C
ouncil #____________
DATE OF ELECTION____________________
REPORT OF OFFICERS CHOSEN FOR THE TERM
JULY 1, 20__ TO JUNE 30, 20__
