MEMBER INTEREST SURVEY

As a member of this council, you are our greatest asset. We value your judgment, we appreciate your opinions and we rely on your participation for continued success.

Since joining the Knights of Columbus, you have undoubtedly become familiar with many of our varied programs of involvement – programs where you can personally apply your talents and fulfill your ambitions. In an effort to satisfy your desires and interest, we ask that you complete the following survey and return it to our membership committee for evaluation and action.

SERVICE PROGRAM INVOLVEMENT

Please list your preferences for possible committee assignments. Mark those areas, which you find exciting, challenging, and promising.

Programs

CHURCH	COMMUNITY	COUNCIL	FAMILY	YOUTH
Vocations	Pro-Life	Public Relations	Survivor’s Assistance	Columbian Squires
Parish Round Table	Human Needs	Fraternalism	Memorials	Youth Groups
Lay Apostolate	Civic Involvement	Cultural	Education	Athletics
Parochial Services	Environment	Social	Communications	Educational Programs
Religious Devotions	Public Safety	Blood Donors	Family of the Month/Year	Youth Welfare
Christ in Christmas	Health Services	Athletics	Family Projects	Substance Abuse
	Decency		Recreation	Social Activities
Other, Specify	Other, Specify	Other, Specify	Other, Specify	Other, Specify
__________________	________________	________________	______________________	____________________

Membership

Recruitment

Retention

Insurance Promotion

Admissions Committee

Ceremonials

In your opinion, how can our council improve existing programs? Please be specific.

INSURANCE PARTICIPATION

NON-INSURANCE MEMBER? If you are not currently enrolled as an insurance member, would you like our Supreme Council Insurance Representative to contact you to explain the many benefits available through the Order’s insurance program?

Yes No

INSURANCE MEMBER? If you are an insurance member, would you like our +Supreme Council Insurance Representative to contact you to explain new and additional benefits available through the Order’s insurance program?

Yes No

Survey completed by:

Date:

^{(First and Last Name)}

^{(Street Address)}

^{(City) (State) (Zip Code)}

Revised 29-Jul-2010

Please print this form, complete it by hand writing in the information and return this form to Grand Knight Brian Nelsen.