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 https://utahknights.org/2021/05/fourth-degree-exemplification-12-jun-2021/

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: https://utahknights.org/fourth-degree/#form4
Email *
Formal Name (for new Sir Knight Certificate) *
Example: Joseph Q. Knight
Your Name (or Nickname) *
Example: Joey Knight
Phone Number *
Your (mobile) phone number, e.g., 801-555-1234
Reason for registration *
Why will you be watching the exemplification?
Membership Number *
Your membership number is on your Knights of Columbus membership card(s).
State *
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.
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.
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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