Louisville, KY 

Fill out this registration form for the 2011 K of C Swim Club, attach check & mail.

NAME: __________________________________________     ____________________________________________
              (last)                                                                                 (first)

( ) Spalding Council ($70) _____________________________( ) Member of : _________________________Council ($105)

K of C Membership Number: ___________________________Wife's Name:_____________________________________

Address: _________________________________________________________Zip Code:__________________________

Phone Numbers: Home: _____________________Father Work:_____________________ Wife:______________________

(PHONE NUMBERS ARE MANDATORY IN CASE OF EMERGENCY)

CHILDREN: (can list five (5) under 18) Additional Children: (add $15 per child)
 __________________________________________   ___________________________________________________

 __________________________________________    ___________________________________________________

 __________________________________________    ___________________________________________________

 __________________________________________    ___________________________________________________

___________________________________________   ____________________________________________________

Name Age Name Age

FEMALE CHILDREN: (18 or older, add $40 per child)
 ____________________________________________   ________________________________________________

 ____________________________________________   ________________________________________________

GRANDPARENTS: (as substitute for parents) ($70)

NAME: ____________________________________________________    _________________________________
             (last)                                                                                                    (first)

Address: ___________________________________________________________Zip Code:_______________________

Attach check payable to: Knights Corporation: Mail to: 4417 River Road, Louisville, KY 40222 Attn: Swim Club