KNIGHTS OF COLUMBUS ILLINOIS STATE COUNCIL

STATE DIRECTORY INFORMATION - DIR1
Use to Report Assembly Information

This form is for use by Faithful Navigators 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

Assembly Name: *

Assembly #: *

Meeting Location STREET Address: *

PO Box #: *

City: *

Zip Code + 4 Code (If known) *

Meeting Location Phone #:

Fax #:

Assembly meets on what days of the month (i.e., 2nd & 4th Thurs, etc) *

Do you have an Assembly Website *

Yes

No

Assembly Website URL Address:

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 E] Other

FAITHFUL NAVIGATOR INFORMATION

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

No Change in Information

Name:

Membership #:

Spouse (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:

What contact numbers do you want to appear in the State Directory? *

FAITHFUL COMPTROLLER INFORMATION

IF THERE IS NO CHANGE IN FAITHFUL COMPTROLLER INFORMATION, PLEASE CHECK BOX (You do not have to complete the FC 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:

What contact numbers do you want to appear in the State Directory? *

If you are mailing this form, please return it to:

Illinois State Council

PO Box 681

Kankakee, IL 60901-0681

Remember to save a copy of this form before sending it electronically.