St. Timothy Assembly #3029 Interest Form

1730 West Guadalupe Road • Mesa, Arizona 85202

Membership Interest Form

Thank you for your interest in joining Knights of Columbus St. Timothy Assembly. Please fill out the interest form with as much information as you wish to share about yourself. The form will be emailed to our Membership Chair, Sir Knight Joe Van Parys. He will be contacting you within a few days of your submission.

General Information

* Name:
* Address:
* City:
* State:
* Zip Code:
* Home Phone:
Work Phone:
Cell Phone:
Email address:
Date of Birth:
Place of Birth:
Marital Status:	Married Single Widower Divorced
If married, wife's name:
Number of children:	Boys Girls
Occupation:
Employer:
Parish:
Hobbies:

Membership in the Fourth Degree Knights of Columbus is open to third degree Knights who have been a Knight for at least one year. By submitting this interest form, you attest that you meet the requirements to join.

* Required information

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