State of North Carolina
  Knights of Columbus
     State Relocation Report

Council Name           Council Number

Council Contact Name

Phone   E-Mail

Name of Knight

Old Address

New address

Old Phone number- Home Cell

New Phone number Home Cell

Other info on the member Employer , emergency contact numbers, children:

Member Number Insurance Member   Yes      No

Wife’s name E-Mail Address

This report will be emailed to your RDD or Bob Hack   
                                                                  373 Broadleaf Lane SE
                                                                  Bolivia NC 28422
                                                                   hackbob42@atmc.net

To send this report to your Regional District Deputy enter his email address here
His eamil address is rdd_@kofcnc.org