KNIGHTS OF COLUMBUS

ILLINOIS STATE COUNCIL

STATE DIRECTORY INFORMATION:
Use to Report Assembly Information

This form is for use by Financial Secretaries and Faithful Comptrollers ONLY to report their Assembly information and contact information for the State Directory.

READ THIS BEFORE YOU COMPLETE THIS FORM.

This information will appear in our State Directory: Please provide your COMPLETE address including: Directions (N, S, E, W), Avenue, Street, Drive, Lane etc.

Be sure to show your PO Box AND your HOUSE ADDRESS. The State Office needs BOTH addresses

ASSEMBLY INFORMATION

IF THERE IS NO CHANGE IN ASSEMBLY INFORMATION, PLEASE CHECK BOX (You do not have to complete the ASSEMBLY Information if you check this box)

No Change in Information

Assembly Name:

Assembly #:

Meeting Location STREET Address:

PO Box #:

Number of members::

City:

Zip Code + 4 Code (If known)

Mailing Address (If different than meeting location address)

Meeting Location Phone #:

Fax #:

Assembly Meets on What Days of the Month (i.e., 2nd & 4th Thurs, etc)

Assembly Website URL:

Assembly e-mail address:

TYPE OF MEETING FACILITY:

A] Meets at church or school hall - On meeting nights only

B] Clubroom building- rental - Open meeting nights only

C] Clubroom - K of C facility - Open to members only

D] Clubroom - K of C facility - Open to Public

E] Other

FAITHFUL NAVIGATOR INFORMATION

IF THERE IS NO CHANGE IN FAITHFUL NAVIGATOR INFORMATION, PLEASE CHECK BOX (You do not have to complete the FN Information if you check this box)

No Change in Information

Name:

Membership #:

Spouse (Print clearly as you want it to appear in Directory)

HOUSE Address:

Apt., Lot, Unit or Condo #:

AND PO Box #: (State office needs BOTH addresses)

City:

State

Zip Code + 4: (If Known)

Home Phone #

Business #:

Fax #:

Cell #

E-Mail Address:

FAITHFUL COMPTROLLER

Name:

Membership #:

Spouse (Print clearly as you want it to appear in Directory)

HOUSE Address:

Apt., Lot, Unit or Condo #:

AND PO Box #: (State office needs BOTH addresses)

City:

State

Zip Code + 4: (If Known)

Home Phone #

Business #:

Fax #:

E-Mail Address:

Indicates Response Required