Motorcycle Program Motorcycle Program KofC Member Name(Required) First Middle Initial Last Spouse Name (Optional)Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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)Your NameYour NameYour NameYour NameDate Δ
