Fourth Degree Knights of Columbus Interest Form

The information submitted on this form will be used only in order to contact you as you have directed and for no other purpose.  It will not be saved or used on any mailing lists, databases or be sold.

E-mail Address: *
Full Name *
Address (Street, City, State, Zip Code) *
Are you married? *Yes
Telephone number (10-digit) *
Third Degree member in good standing? *Yes
How long have you been a 3rd Degree Knight? *
Less than 6 months
At least 6 months but less than one year
Over one year
How would you like to be contacted? *
Contact me by email
Phone me and speak to me in person
Phone me and leave a message if I am not in
What is the best time to contact you? *
Before noon
Noon to 6:00 PM
After 7:00 but before 10:00
What Council (name & number) do you belong to? *
Who is your Financial Secretary?
Which Assembly would you like to join?

Verification Code:
Enter Verification Code: *

* Required