State of North Carolina
  Knights of Columbus
     State Relocation Report

Council Name           Council Number

Council Contact Name

Phone

E-Mail

Name of Knight

Member Number

Insurance Member   Yes      No

Wife’s name

E-Mail Address

Old Address

New address ( As much as Known )

Old Phone number- Home Cell

New Phone number Home Cell

Anything else to find him ?? Employer , emergency contact info Etc.

This report goes to Retention Director Bob Hack