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Motorcycle Program

KofC Member

Name(Required)

First Middle Initial Last

Spouse Name (Optional)

Address(Required)

Street Address City State ZIP Code

Home Phone #

Cell Phone #(Required)

Email(Required)

Diocese Name(Required)

Parish Name(Required)

KofC Council Number(Required)

Current Grand Knight(Required)

Are you a 4th degree member?(Required)

Yes

No

Assembly #(Required)

Do you own a street motorcycle?(Required)

Yes

No

Do you have an endorsement?(Required)

Yes

No

Do you have insurance?(Required)

Yes

No

Are you in good standing with your parish and council?(Required)

Yes

No

Signature(Required)

Date

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