In Memoriam

KNIGHTS OF COLUMBUS

ILLINOIS STATE COUNCIL

STATE NEWSLETTER: In Memoriam Column

Council Name: *

Council Location (City) *

Council #: *

First Name, M.I. of deceased *

Last Name of Deceased: *

Date of Death:(##/##/####) *

Years of Membership *

What is highest Degree attained: 1, 2, 3, 4 *

Positions Held (Check all positions that apply) *

Next of Kin Information

Widow or Next of Kin Name

Street Address *

City *

State *

Zip Code *

Phone Number

Email Address

Your Information

Your Name *

Your Email Address *

When you click submit, this form will autmatically be emailed to the State Office, the In Memoriam Chairman, and a copy will be emailed to you which you can then send to anyone else that needs to be notified.