Illinois State Council Knights of Columbus 2nd Responder Disaster Volunteer

I am a member of the Knights of Columbus *

YES

NO

Member Number

Council Number

Title

First Name *

Middle Name

Last Name *

Suffix

Address 1 *

Address 2

City *

State (Pick 1) *

Zip Code *

Diocese you live in: *

Preferred Method of Contact:* *

Home Phone

Cell Phone

Work Phone

E-mail Address *

Tell us a bit more about yourself. Do you have any disaster response experience or training? Affiliated with any other emergency response organization?

What other volunteer efforts could you assist in? Examples of general volunteer work could be serving meals or helping at a council hall, clearing debris, or collecting and distributing survival items.