State of North Carolina
  Knights of Columbus 
State Chancellor's - Raleigh
Information Sheet

From:    Email

To be distributed to:    STATE   REGION    DISTRICT    OTHER

DEATH:  Member’s Name     Council  

DOD Highest Degree Highest Office

Arrangements

KEYNOTE BIRTHDAY: Member’s Name Council

Birthdate     Age

Additional Info

KEYNOTE WEDDING ANNIVERSARY:   Member’s Name

Wife’s Name Anniversary Date 10th  25th  50th

Additional Info:

KEYNOTE KofC ANNIVERSARY: Member’s Name:

Wife’s Name: Date Joined Order

Office’s Held

4th Degree Member     Yes   No  Year Joined 4th Degree

ANY OTHER INFO:

This form will be emailed to: (East Raleigh Diocese)                                      

      East-Raleigh Diocese
      Hadon Ware
      skhewsr@yahoo.com
      919 878-9893 W or Cell 919 623-4839