State Directory Form

State Council-MISC-Dir-GK & FS

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.
COUNCIL INFORMATION
* Council Name:
* Council #:
* Meeting Location STREET Address:
* PO Box #:
* City:
* Zip Code + 4 Code (If known)
Meeting Location Phone #:
* Council Meets on What Days of the Month (i.e., 2nd & 4th Thurs, etc)
Council Website URL Address:
Council e-mail address:
* TYPE OF MEETING FACILITY:




GRAND KNIGHT INFORMATION
IF THERE IS NO CHANGE IN GRAND KNIGHT INFORMATION, PLEASE CHECK BOX
 
Name:
Membership #:
Spouse (As you want it to appear in Directory)
Address:
Apt., Lot, Unit or Condo #:
City:
State
Zip Code + 4: (If Known)
Home Phone #
* Cell #:
E-Mail Address:
* What contact numbers do you want to appear in the State Directory?
 
FINANCIAL SECRETARY INFORMATION
[As appointed by Supreme Council]
IF THERE IS NO CHANGE IN FINANCIAL SECRETARY INFORMATION, PLEASE CHECK BOX
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 #
* Cell #:
E-Mail Address:
* What contact numbers do you want to appear in the State Directory?
CHAPLAIN INFORMATION
Name:
Membership #:
HOUSE Address:
Apt., Lot, Unit or Condo #:
AND PO Box #:  (State office needs BOTH addresses)
City:
State
Zip Code + 4: (If Known)
Home Phone #
* 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:

Indiana State Council

431 E Lynnwood Dr N

Warsaw, IN 46580-7551

 Remember to save a copy of this form before sending it electronically.
* Indicates Response Required