Report Of Round Table Coordinator Page 2

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MEMBERSHIP NUMBER
LAST NAME
FIRST NAME
INITIAL
(5) ROUND TABLE COORDINATOR:
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
STREET
CITY
STATE
ZIP
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
PHONE NO.
PARISH:
CITY:
–––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
NUMBER OF COUNCIL MEMBERS AT THIS PARISH:
NUMBER OF FAMILIES AT PARISH:
–––––––––––––
–––––––––––––
MEMBERSHIP NUMBER
LAST NAME
FIRST NAME
INITIAL
(6) ROUND TABLE COORDINATOR:
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
STREET
CITY
STATE
ZIP
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
PHONE NO.
PARISH:
CITY:
–––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
NUMBER OF COUNCIL MEMBERS AT THIS PARISH:
NUMBER OF FAMILIES AT PARISH:
–––––––––––––
–––––––––––––
MEMBERSHIP NUMBER
LAST NAME
FIRST NAME
INITIAL
(7) ROUND TABLE COORDINATOR:
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
STREET
CITY
STATE
ZIP
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
PHONE NO.
PARISH:
CITY:
–––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
NUMBER OF COUNCIL MEMBERS AT THIS PARISH:
NUMBER OF FAMILIES AT PARISH:
–––––––––––––
–––––––––––––
MEMBERSHIP NUMBER
LAST NAME
FIRST NAME
INITIAL
(8) ROUND TABLE COORDINATOR:
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
STREET
CITY
STATE
ZIP
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
PHONE NO.
PARISH:
CITY:
–––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
NUMBER OF COUNCIL MEMBERS AT THIS PARISH:
NUMBER OF FAMILIES AT PARISH:
–––––––––––––
–––––––––––––
MEMBERSHIP NUMBER
LAST NAME
FIRST NAME
INITIAL
(9) ROUND TABLE COORDINATOR:
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
STREET
CITY
STATE
ZIP
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
PHONE NO.
PARISH:
CITY:
–––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
NUMBER OF COUNCIL MEMBERS AT THIS PARISH:
NUMBER OF FAMILIES AT PARISH:
–––––––––––––
–––––––––––––
MEMBERSHIP NUMBER
LAST NAME
FIRST NAME
INITIAL
(10) ROUND TABLE COORDINATOR:
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
STREET
CITY
STATE
ZIP
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
PHONE NO.
PARISH:
CITY:
–––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
NUMBER OF COUNCIL MEMBERS AT THIS PARISH:
NUMBER OF FAMILIES AT PARISH:
–––––––––––––
–––––––––––––
MAIL ORIGINAL TO:
Supreme Council, Department of Membership Growth and Ceremonials
MAIL COPIES TO: State Deputy, District Deputy, Council File
___________________________________________ Grand Knight
2629
11/11

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