2021.06.12 Utah District Virtual Fourth Degree Exemplification Registration
Please complete this form completely. The GoToWebinar link will be sent to those who are properly registered. More information about registration is available at
Brother Knights who are interested in being Sir Knights may complete their Form 4 application (instructions are available) and once all the required signatures are complete, send it in with the $50.00 payment to the Utah District Master. The application and payment must be received no later than 6-JUN-2021. Note: There is no banquet dinner for this exemplification. Form 4 & instructions are here:
Formal Name (for new Sir Knight Certificate)
Example: Joseph Q. Knight
No Certificate (already a member of the fourth degree)
Your Name (or Nickname)
Example: Joey Knight
Your (mobile) phone number, e.g., 801-555-1234
Reason for registration
Why will you be watching the exemplification?
Candidate (joining the Fourth Degree, watching by myself)
Candidate (joining the Fourth Degree, watching in a group)
Observer (Sir Knight watching alone)
Sir Knight hosting a group (e.g., at a church) with or without candidates
Your membership number is on your Knights of Columbus membership card(s).
What state is your council in?
Assembly Number (and name)
Please select the Utah assembly you're joining, or (if out of state) manually enter your assembly number below. Name is optional.
Utah 1144 - Father Francisco Atanasio Dominguez
Utah 1146 - Father Escalante
Utah 1429 - Rt. Rev. Msgr. Patrick M. Cushnahan
Utah 1570 - Carbon
Utah 2393 - Bishop Scanlan
Utah 2577 - Reverend Thomas J. Meersman
Utah 2636 - Padre Pio
Utah 3501 - Saint John Paul II
Utah 3586 - Rev. Msgr. Robert C. Pollock
Utah 3758 - Monsignor John J. Sullivan
Council Number (and name)
Please select the Utah council to which you belong, or (if out of state) manually enter your council number below. Name is optional.
Utah: 602 - Salt Lake
Utah: 777 - Ogden
Utah: 1129 - St. Mary's
Utah: 1136 - Fr. Escalante
Utah: 2611 - St. Anthony
Utah: 5214 - Bishop Hunt
Utah: 5347 - Father DeSmet
Utah: 5502 - St. Olaf’s
Utah: 6010 - St. Rose of Lima
Utah: 6147 - Msgr. Giavonnoni
Utah: 6739 - St. Marguerite’s
Utah: 6966 - Corpus Christi
Utah: 7401 - Bishop Scanlan
Utah: 7961 - St. Joseph the Worker
Utah: 8350 - St. Peter and Paul
Utah: 8606 - Msgr. Edward F. Dowling
Utah: 9561 - Fr. Dominguez
Utah: 9731 - Our Lady of Lourdes
Utah: 9849 - St. James
Utah: 10304 - St. Martin de Porres
Utah: 10733 - Vic Giasson
Utah: 11246 - Fr. Joseph Valine
Utah: 11479 - St. Thomas More
Utah: 11812 - San Felipe
Utah: 12181 - Mother Teresa of Calcutta
Utah: 12264 - St. Patrick
Utah: 12959 - St. Thomas Aquinas
Utah: 13297 - St. Vincent’s
Utah: 13646 - St. Therese of the Child Jesus
Utah: 14239 - St. Andrew
Utah: 14399 - Bishop Joseph L. Federal
Utah: 14764 - Fr. Thomas Craft
Utah: 15418 - St. Ambrose
Utah: 15741 - Our Lady of Guadalupe
Utah: 16006 - Sacred Heart
Utah: 16127 - Deacon Douglas R. Sliger
Utah: 17140 - Immaculate Conception
Notes for Utah District Master
Anything else you need to mention? If you will be in a group, where will the group be located?
A copy of your responses will be emailed to the address you provided.
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