Knights of Columbus
Simi Valley - St. Peter Claver - Council 9410
Annual Dues Payment Form
"
*
" indicates required fields
Name
*
First
Last
Email
*
Phone
*
Select from the following options
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1 year - $35
2 years - $70
3 years - $105
Optional - Special Assessment
*
Yes - Add the additional $3.65 For Help Brother Fund
No - I'm opting out this year.
Optional - Special Assessment
*
Yes - Add the additional $7.30 For Help Brother Fund
No - I'm opting out.
Optional - Special Assessment
*
Yes - Add the additional $10.95 For Help Brother Fund
No - I'm opting out.
Total
Credit Card
*
Card Details
Cardholder Name
