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["The member and officers' signatures are required for this form to be processed"]
["Please complete this form legibly"]
["100  3/15",{"$nulls":6},"KNIGHTS",{"$nulls":11},"Membership Document"]
[{"$nulls":7},"OF COLUMBUS",{"$nulls":11},"A CATHOLIC, FAMILY, FRATERNAL, SERVICE ORGANIZATION"]
[{"$nulls":7},"1 COLUMBUS PLAZA, NEW HAVEN, CT. 06510"]
[1,"NEW/RECEIVING COUNCIL NUMBER",{"$nulls":7},"COUNCIL LOCATION (CITY, ST/PROV)",{"$nulls":7},"MEMBER NUMBER",{"$nulls":7},"DATE READ",{"$nulls":3},"DATE ELECTED",{"$nulls":3},"1ST DEGREE DATE"]
[null,12985,{"$nulls":7},"Montague, MI."]
[2,"TRANSACTION",{"$nulls":18},"DEATH",null,null,"MO    DAY    YR",{"$nulls":3},"PROVIDE SURVIVOR INFORMATION BELOW"]
[{"$nulls":27},"NEXT OF KIN"]
[{"$nulls":20},"RELATIONSHIP",{"$nulls":7},"PHONE #"]
[{"$nulls":20},"STREET"]
[{"$nulls":20},"CITY",{"$nulls":6},"ST/PROV",{"$nulls":3},"ZIP CODE"]
[{"$nulls":12},"reason"]
[3,"LAST NAME:",{"$nulls":8},"FIRST NAME:",{"$nulls":8},"MIDDLE INITIAL:",{"$nulls":7},"TITLE:"]
[]
[null,"STREET:",{"$nulls":8},"CITY:",{"$nulls":5},"ST/PROV:",{"$nulls":4},"POSTAL CODE",{"$nulls":5},"COUNTRY (OUTSIDE US)"]
[{"$nulls":16},"MICHIGAN",{"$nulls":10},"USA"]
[null,"DATE OF BIRTH",{"$nulls":4},"MARITAL STATUS",{"$nulls":4},"HOME PHONE",{"$nulls":8},"BUSINESS PHONE",{"$nulls":8},"CELL PHONE"]
[null,"MO   DAY   YR"]
[]
[null,"E-MAIL ADDRESS",{"$nulls":12},"OCCUPATION/EMPLOYER",{"$nulls":11},"LAST 4 DIGITS OF TAX ID (e.g. SSN, SIN)"]
[{"$nulls":26},"XXXXX - "]
[4,"ARE YOU A PRACTICAL OR PRACTICING CATHOLIC IN UNION WITH THE HOLY SPIRIT?",{"$nulls":8},"YES","NO","PARISH NAME, LOCATION (CITY, ST/PROV)",{"$nulls":18},"FORMER COLUMBIAN SQUIRE?",{"$nulls":3},"YES","NO"]
[]
[null,"DID YOU APPLY FOR MEMBERSHIP PREVIOUSLY?",{"$nulls":5},"YES","NO","INVITATION DATES",{"$nulls":3},"1. FIRST",{"$nulls":5},"2. SECOND",{"$nulls":5},"3. THIRD",{"$nulls":5},"4. FOURTH"]
[]
[null,"DATE OF TERMINATION",{"$nulls":5},"REASON:",{"$nulls":11},"NUMBER OF LAST COUNCIL",{"$nulls":6},"COUNCIL LOACATION (CITY, ST/PROV."]
[]
[5,"I HEREBY RECOMMEND THE ABOVE APPLICANT FOR MEMBERSHIP",{"$nulls":15},"I HEREBY DECLARE THAT THE ABOVE IS TRUE AND CORRECT AND THAT I WILL UPHOLD THE CHARTER CONSTITUTION AND LAWS OF THE KNIGHTS OF COLUMBUS AND ANY OF ITS COUNCILS IN WHICH I HOLD MEMBERSHIP AND AGREE THAT THE DECISION OF THE BOARD OF DIRECTORS SHALL CONTROL IN ALL MATTERS.  I AGREE THAT THE KNIGHTS OF COLUMBUS MAY VARIFY THE INFORMATION PROVIDED."]
[]
[null,"PRINT NAME OF PROPOSER"]
[]
[null,"PROPOSAL MEMBERS NUMBER (required) "]
[{"$nulls":17},"SIGNATURE OF APPLICANT"]
[]
[null,"DATE",{"$nulls":3},"FINANCIAL SECRETARY SIGNATURE ",{"$nulls":15},"GRAND KNIGHT SIGNATURE "]
["    Print and sign three (3) copies.  Check box to right where copy is sent to."]