Exemplification Registration

Knights of Columbus - District 3
Fourth Degree Exemplification

Registration

Please answer ALL questions before submitting form

Member Number *

Phone *

Attend as: *

New Candidate ** $70 - Includes your lunch

Current 4th Degree Member - Additional cost for lunch

First Name *

Last Name *

Council Number *

Assembly Number *

District

Address *

City *

State/Province *

Zip Code *

Email Address *

Registration for: *

Marysville - May 10,2025

Spouse, Guest or SK Attending lunch $20 *

YES

NO

Class Picture

Calss picture - $10.00

NOTE: ** Make payments to your ASSEMBLY. The Assembly will write one check to the District Master.

Terms and Conditions *

You consent to receive communications from us electronically. We will communicate with you by e-mail or phone. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing.