42nd Annual - Knights of Peter Claver

53rd Annual
Louisiana Junior KPC State Conference
June 20th -22nd, 2014
TO:
National Officers, Supreme Officers, Louisiana State Officers, Grand Knights, Grand Ladies,
Commanders, Counselors, Officers & Members of KPC, KPCLA
FROM:
Brother Harold Narcisse, Louisiana State Director
Lady Cheryl Flotte, Louisiana State Directress
RE:
2014 Jr. Louisiana KPC State Conference
THEME:
"Keep Calm and Love Jesus"
Greetings:
The Louisiana State Conference, Junior Division, will hold its 53rd Annual Conference in Lafayette,
Louisiana on June 20-22, 2014. The host hotel will be the Ramada Inn. The members of Teche Central
Committee District III are the hosts and hostesses of this years’ Conference.
This packet contains all of the forms you will need to complete your registration process. All deadlines
for credentials and competitions are set for May 1, 2014. Please send the FULL AMOUNT REQUESTED
for credentials to the designated address on the credentials form. Acceptable methods of payment will
be: Council/Court/Branch Check, money order, or cashier’s check. ALL DEADLINES MUST BE ADHERED
TO.
Please Note:
 All monies for credentials fees ($30.00 per unit), Sickle Cell Donation Checks must be made
payable to: KPC Louisiana State Conference.
 Please make separate checks for each transaction and put the transaction type in the Memo
section of your check (i.e. Credentials)
Please encourage all of your juniors to participate in this year’s Junior Conference, events and
competitions. At any time, if you have any questions or problems, please do not hesitate to contact us at
the addresses listed below.
IF YOU ARE NO LONGER THE COMMANDER OR COUNSELOR,
PLEASE FORWARD THIS PACKET TO THE PROPER PARTY.
Director / Directress Addresses:
Brother Harold Narcisse
Louisiana State Jr. Knight Director
3578-A Main Hwy
Breaux Bridge, LA 70517
(337) 332-1169 or (337) 789-4624
Email: [email protected]
Lady Cheryl Flotte
Louisiana State Jr. Daughter Directress
P. O. Box 52853
New Orleans, LA 70152
(504) 373-1498
Email:[email protected]
53rd Louisiana Jr. KPC State Conference
June 20th -22nd, 2014
Ramada Inn – Lafayette, LA
Conference Registration/Hotel Reservations
You will be receiving a separate packet from the District III concerning the conference
registration, hotel information and T-shirts. If you do not receive a packet, please contact one of
the conference chairpersons: Lady Darlene Gibson and Brother Isaac Bowie III
Jr. Conference Credentials Submittal
Junior KPC State Conference Credentials must be received on or before May 1, 2014. (Please note that
all forms and fees must be received by the deadline date NOT POSTMARKED by the deadline date). All
participating branches and courts must pay a credential fee of $30.00 per branch/court. Acceptable
methods of payment: council/branch/court check, money order or cashier’s check made payable to: KPC
Louisiana State Conference. Personal Checks or cash are not accepted. Credentials fees must
accompany a completed Credentials Form. Send $30 Credential fee and appropriate form to the
following: NO FUNDS WILL BE ACCEPTED ONSITE
Jr. Knights
Brother Harold Narcisse
Louisiana State Director
3578-A Main Hwy
Breaux Bridge, LA 70517
(337) 332-1169 or (337) 789-4624
Jr. Daughters
Lady Cheryl Flotte
Louisiana State Directress
P. O. Box 52853
New Orleans, LA 70152
(504)373-1498
Conference/Hotel Rules & Code of Conduct Dress Code
Please review and make a copy of these rules for all attendees to the Jr. State Conference. All attendees
are required to abide by these rules and dress code.
KPC – Jr. Knight/Jr. Daughter Release and Consent Form
KPC Child Protection Policy requires ALL Juniors to complete this form. These forms must be sent in
advance to the Director or Directress along with your credentials form.
KPC – Child Protection Certification
KPC Child Protection Policy requires that ALL adult attendees (whether a member of KPC or not)
complete the Diocesan Certification for your church parish. This form must be completed for each adult
attendee, signed by the Grand Knight/Grand Lady, and contain the Council/Court Seal. These forms must
be sent in advance to the Director or Directress along with your credentials form. For more information
about your diocesan training, please contact your local diocese about the “Child Safe Environment”
program and training. According to the KPC Child Protection, all Chaperones must 21 years.
2014 Jr. KPC Conference Checklist
Make copies of completed forms before sending out to the proper parties: Credentials (3) copies,
Registration (3) copies, Child Protection Certification Forms (2) copies, Consent Forms (2) copies,
Media Release (2) and Adult Waiver Release.
Make your hotel reservations with the Ramada Inn no later than May 1, 2014. One night’s stay for
each room is required when making reservation.
Mail Original Copy of Registration form along with your $75 fee per attendee to Brother George
Williams Junior Knights Registration Chairperson, P.O. 14156 New Iberia, LA. 70562 and to Ladies
Sherial Scott or Deidra Bowie Junior Daughter Registration Co-Chairperson, P.O. 14156 New Iberia,
LA.
Mail Original Copy of Credentials Form to the Director or Directress no than May 1, 2014 along
with your $30 Credentials fee.
Mail Individual and Unit Competitions forms no later than May 1, 2014 to the address on the
forms.
Mail Jr. Knight/ Daughter of the Year Essay, Cover Letter and any additional documentation to the
Director or Directress no later than May 1, 2014.
Mail Jr. Essays no later than May 1, 2014 to the address listed in the instructions.
Submit Sickle Cell donation to Information Desk by 9am June 21st. Make Branch/Court Checks or
money orders payable to: KPC LA State Conference. Put in the memo section: Sickle Cell.
Drop off Baby Shower donation to the Information Desk by 9am June 21st.
Encourage your juniors to participate in all of the activities.
KPC JR. STATE CONFERENCE / HOTEL
RULES & CODE OF CONDUCT

THE SWIMMING POOL IS STRICTLY OFF LIMITS. The Conference Headquarters, Hosts, and the
National Office WILL NOT be responsible for ANY accidents. This rule applies to ALL in
attendance, including the chaperones.

Each Court/Branch will be responsible for making juniors aware of the Conference Rules & Code
of Conduct and the Dress Codes.

NO junior will be allowed to bring jam boxes or loud music. Nor will any junior be allowed to just
sit and loiter in common areas.

Junior Knights/Daughters MUST be supervised at ALL times. DO NOT leave your juniors in their
rooms alone or running around the hotel unsupervised. We have planned activities for the juniors
and ALL Juniors SHOULD be in a meeting or supervised.

FOLLOW the AGENDAS – Ask Questions. Juniors are here to take care of their State Conference
Business.

One (1) Chaperone to every Four (4) juniors.

CURFEW FOR JUNIORS WILL BE STRICTLY ADHERED TO:
Thirty (30) minutes after the completion of the Talent Show and Thirty (30) minutes after the
completion of the Dance.

Juniors who are in violation of any of these rules or disruptive, risk the entire Court/Branch being
disciplined for their actions.

All attendees of the Conference, including chaperones, are to abide by the Conferences rules and
code of conduct.

Commanders/Counselors and Chaperones: Please read and distribute the above rules and
regulations to juniors and Parents. Thank you for your cooperation.
KPC JUNIOR LOUISIANA STATE CONFERENCE REVISED DRESS CODE
ACCEPTABLE ATTIRE IS AS FOLLOWS: Dress code will be strictly enforced. Chaperones and Adults must also
adhere to Dress Code.
EVENT
FRIDAY
SESSION/COMPETITIONS
TALENT SHOW
JUNIOR KNIGHTS
FRIDAY ( TRAVEL DAY)
Blue Jeans/slacks & shirts.
Casual shoe or tennis shoes with
socks.
Shirts must be worn
inside slack/jeans. NO shorts,
tank tops, or muscle shirts.
Blue Jeans/slacks & shirts.
Casual shoe or tennis shoes with
socks.
Shirts must be worn
inside slack/jeans. NO shorts,
tank tops, or muscle shirts.
JUNIOR DAUGHTERS
Jeans or slacks with blouses. Dresses or
skirts & blouses. Tennis shoes or sandals.
NO tank tops, t-straps, strapless, midriff,
spandex or halter tops. NO spandex skirts
or pants, NO shorts. Stockings optional.
Jeans, slacks, capris or Bermuda shorts
ONLY with blouses or tops. Dresses or
skirts & blouses. Tennis shoes or sandals.
NO tank tops, t-straps, strapless, midriff,
spandex or halter tops. NO spandex skirts
or pants. Stockings optional.
SATURDAY
SATURDAY SESSION
Dress shirt, necktie, dress pants
( no jeans) coat (optional) Dress
shoes ( no sneakers or tennis
shoes NO shorts, tank tops, or
muscle shirts.
CONFERENCE MASS
Dark suits or dark slacks with
white dress shirt and tie. Dress
or casual shoes with matching
socks. NO jeans, tennis shoes,
sandals.
AWARDS RECEPTION
AND GALA(Formal/SemiFormal)
Shirt and Necktie, Coat and dress
pants ( No Jeans), Dress shoes (
No tennis shoes, sneakers or
sandals)
Business Attire: Slacks with blouses. ( No
distressed fabric) Dresses or skirts with
modest length. No Tennis shoes, NO tank
tops, t-straps, strapless, midriff, spandex
skirts or pants, halter tops or shorts.
Stockings optional.
White knee-length dress or white skirt
with white elbow-length or long sleeved
blouse. Jr. Daughter Official Kufi Hat
(chapel veils if unavailable), white purse
(optional), white gloves (NOT lace or
leather), skin toned stockings or white
socks. ALL accessories must be WHITE.
NO Ribbons as head coverings. NO
GRAY or WHITE STOCKINGS. NO
strapless or t-straps. NO halter-tops.
Formal, Semi-Formal or Dressy Dress
(Shoulders, back, or midriff should be
covered at all times. Splits should not be
higher than the top of the knee.) Dress
shoes
SUNDAY
SUNDAY SESSION
(Dress-Down Day)**
Branch shirt or Conference
Souvenir T-shirts with Jeans,
tennis shoes or casual shoes. **If
you do not wear conference
t-shirt or branch shirt, you must
wear the standard meeting
attire.
Court shirt or Souvenir Conference T-shirt
with Jeans, tennis shoes or sandals, socks
or stockings optional. **If you do not
wear conference t-shirt or court shirt, you
must wear the standard meeting attire.
JR. KNIGHTS & JR. DAUGHTERS
2014 JR. LOUISIANA STATE CONFERENCE
CODE OF ETHICS AND DRESS CODE
I have read the code of ethics and dress code sheet of information:
Signature of Junior Member Signature of Junior Parent
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KNIGHTS OF PETER CLAVER
PARENTAL/GUARDIAN CONSENT FORM AND LIABILITY WAIVER
Junior Knight/Junior Daughter name:
Birth date:
Branch/Court Name:
Parent/Guardian’s name:
Home address:
Home phone:
Alternate phone:
I,
grant permission for my child,
to participate in the Knights of Peter Claver and Ladies Auxiliary activity that may require transportation to a location
away from their individual branch/court site. This activity will take place under the guidance and direction of the State of
Louisiana Knights of Peter Claver and Ladies Auxiliary and/or volunteers throughout the state. A brief description of the
activity follows:
Type of event:
LA Junior State Conference
Location(s):
Ramada Inn, Lafayette, LA
Individual in charge:
Duration of activity:
Mode of transportation to and from event:
As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor
(“participant”).
I agree on behalf of myself, my child named herein, and my spouse, our heirs, successors, and assigns, to indemnify, hold harmless,
and defend The Knights of Peter Claver and Ladies Auxiliary their members, directors, officers, and representatives associated
with the event arising from or in connection with the negligence and/or intentional acts of my child.
Signature:
Jr. Knights:
Date:
(MAKE 2 COPIES FOR EACH JUNIOR REGISTERED)
Keep (1) copy and forward (1) copy for each junior along with Credentials as follows:
Brother Harold Narcisse
Jr. Daughters: Lady Cheryl Flotte
3578-A Main Hwy
P. O. Box 52853
Breaux Bridge, LA 70517
New Orleans, LA 70152
(337) 332-1169 or (337) 789-4624
(504)373-1498
PLEASE PRINT OR TYPE ALL INFORMATION!
KNIGHTS OF PETER CLAVER AND LADIES AUXILIRY JUNIOR DIVISION
MEDICAL INFORMATION AND CONSENT FORM
GENERAL INSTRUCTIONS TO PARENTS/GUARDIANS:
1.
Please take care in filling out this form. It provides crucial information for caregivers in the event of illness or
medical emergency. Accuracy and thoroughness are encouraged.
2.
Sections I, II and V are mandatory. Sections III and IV provide you with treatment options in non-emergency
situations.
Junior’s name:
Birth date:
Sex:
Parent/Guardian’s name
Home address:
(Street)
(City/State)
Home phone:
(Zip)
Cellular phone:
Other:
SECTION I. MEDICAL MATTERS
As the parent/legal guardian of the above named child, who is currently associated with the Knights of Peter Claver, Inc.
I hereby authorize
or his/her assistants to carry out the wishes I
have named (herein) in areas of emergency medical treatment and other cases of illness. This authorization inclusively
extends from ________, 20___ through _______, 20___. I hereby warrant that, to the best of my knowledge, my child is
in good health, and I assume all responsibility for the health of my child.
Today’s Date:
Signature:
SECTION II.
EMERGENCY MEDICAL TREATMENT
In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or
surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an
emergency, if you are unable to reach me at the numbers listed herein, contact:
Name & relationship:
Phone:
Family doctor:
Phone:
Family Health Plan Carrier:
Policy #:
Signature:
Date:
SECTION III:
OTHER MEDICAL TREATMENT
In the event it comes to the attention of the KPC, its officers, directors, chaperones, or representatives associated with the
activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be
called collect (with phone charges reversed to myself).
Signature
Date:
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SECTION IV: MEDICATIONS
(SIGN ONLY THOSE OPTIONS THAT ARE APPLICABLE)
•
My child is taking medication at present. My child will bring all such medications necessary, and such
medications will be well-labeled. Names of medications and concise directions for seeing that the child takes
such medications, including dosage and frequency of dosage, are as follows:
Signature:
•
Date:
I hereby grant permission for non-prescription medication (such as aspirin, throat lozenges, cough syrup) to be
given to my child, if deemed appropriate.
Signature:
•
Date:
NO medication of any type, whether prescription or non-prescription, may be administered to my child unless the
situation is life-threatening and emergency treatment is required.
Signature:
SECTION V:
Date:
MEDICAL INFORMATION
The parish will take reasonable care to see that the following information will be held in confidence.
Allergic reactions (medications, foods, plants, insects, etc.):
Immunizations: Date of last tetanus/diphtheria immunization:
Does child have a medically prescribed diet?
Any physical limitations?
Is child subject to chronic homesickness, emotional reactions to new situations, sleepwalking, bed-wetting, fainting?
Has child recently been exposed to contagious disease or conditions, such as mumps, measles, chickenpox, etc?
date and disease or condition:
You should be aware of these special medical conditions of my child:
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If so,
KNIGHTS OF PETER CLAVER AND LADIES AUXILIARY
ADULT LIABILITY WAIVER
RELEASE OF LIABILITY
I, _______________________________, agree on behalf of myself, my heirs, assigns, executors, and personal
representatives, to defend, hold harmless, and indemnify The Knights of Peter Claver, Inc. and Ladies
Auxiliary, their members, directors, officers, or representatives from any and all liability claims, loss, or
damage arising from my negligent and/or intentional acts during my participation in the event described below.
Type of event:
LA Junior State Conference
Destination of event:
Ramada Inn, Lafayette, LA
Sponsoring Agent: _____________________________________________________________
Estimated time of departure and return: _____________________________________________
Mode of transportation to and from event: ___________________________________________
___________________________________
Signature
_________________________
Date
________________________________________
Print Name
KPC Louisiana Junior State Conference 2014
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2014 Jr. Louisiana State Conference
KPC Child Protection Policy Certification
I acknowledge that I understand, and agree to comply with the policies in effect for the Knights of Peter
Claver Inc.:
KPC Child Protection Policy
I understand that any action inconsistent with the policy of Knights of Peter Claver Inc., or my failure to
take action mandated by these policy and programs may result in disciplinary action, up to and including
the termination of my voluntary service.
Adult Attendee/Chaperone Name: _______________________________________________________________
Council/Branch/Court Name:________________________________________________________#____________
City/State:_____________________________________________________________________________________________
Adult Attendee/Chaperone Signature: ______________________________________Date_______________
This section to be completed by Commander/Counselor & Sr. Grand Lady/ Knight
I certify that the above individual has completed the diocesan training and background checks in
compliance with the National KPC Child Protection Policy.
Commander/Counselor Signature:____________________________________Date_______________
Sr. Grand Knight/Lady Signature:____________________________________Date_______________
Council/Court Seal
(Form must contain seal to
be accepted)
MAKE 2 COPIES FOR EACH JUNIOR REGISTERED)
Keep (1) copy and forward (1) copy for each Junior along with Credentials as follows:
Jr. Knights:
Brother Harold Narcisse
3578-A Main Hwy
Breaux Bridge, LA 70517
(337) 332-1169 or (337) 789-4624
Jr. Daughters: Lady Cheryl Flotte
P. O. Box 52853
New Orleans, LA 70152
(504)373-1498
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2014 Junior Knight Credential Form
Credential Information
This is to certify that ___________________________________________ Jr. Branch # ___________
(Name of Junior Branch)
in (City) ___________________________________________________, LA (Zip Code) ________________
is a member in good standing of the Louisiana Junior State Conference and will be
in attendance at the Conference to be held on June 20th - 22nd, 2014 at the
Ramada Inn in Lafayette, LA.
Branch Information
Jr.
GrandKnight:_______________________________________________________________________________
______________
Jr. Deputy Grand Knight: _____________________________________________________________________
Delegate: ___________________________________________________________________________________
Delegate: ___________________________________________________________________________________
Alternate Delegate: ________________________________________________________________________
Alternate Delegate:____________________________________________________________________________________ ________
Jr. State Officers: ______________________________________________________________________________
Jr. State Officers: ______________________________________________________________________________
Jr. National Officers: __________________________________________________________________________
Jr. National Officers: __________________________________________________________________________
Contact Information
Address: _________________________________
Phone: ___________________________________
City/State/Zip: ___________________________________
Email Address: ___________________________________
SIGNATURES:
___________________________________________
__________________________________________
JUNIOR GRAND KNIGHT
JUNIOR SECRETARY
___________________________________
__________________________________________
COMMANDER
ASSISTANT COMMANDER
MAKE THREE (3) COPIES. KEEP ONE (1) AND BRING TO CONFERENCE.
MAIL TWO (2) COPIES WITH $30.00 CREDENTIAL FEE TO:
KPC LA STATE CONFERENCE
c/o Brother Harold Narcisse
3578-A Main Hwy
Breaux Bridge, LA 70517
(337) 332-1169 or (337) 789-4624
PLEASE PRINT OR TYPE ALL INFORMATION
CREDENTIALS DEADLINE IS MAY 1, 2014.
NO ON-SITE CREDENTIALS WILL BE ACCEPTED. NO EXCEPTIONS!
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2014 Junior Daughter Credential Form
Credential Information
This is to certify that ___________________________________________ Jr. Court # ___________
(Name of Junior Court)
in (City) ___________________________________________________, LA (Zip Code) ________________
is a member in good standing of the Louisiana Junior State Conference and will be
in attendance at the Conference to be held on June 20th - 22nd, 2014 at the
Ramada Inn in Lafayette, LA.
Court Information
Jr. GrandLady:___________________________________________________________________________________ ______________
Jr. Vice Grand Lady: _____________________________________________________________________
Delegate: ___________________________________________________________________________________
Delegate: ___________________________________________________________________________________
Alternate Delegate: ________________________________________________________________________
Alternate Delegate:____________________________________________________________________________________ ________
Jr. State Officers: ______________________________________________________________________________
Jr. State Officers: ______________________________________________________________________________
Jr. National Officers: __________________________________________________________________________
Jr. National Officers: __________________________________________________________________________
Contact Information
Address: _________________________________
Phone: ___________________________________
City/State/Zip: ___________________________________
Email Address: ___________________________________
SIGNATURES:
___________________________________________
__________________________________________
JUNIOR GRAND LADY
JUNIOR SECRETARY
___________________________________
__________________________________________
COUNSELOR
ASSISTANT COUNSELOR
MAKE THREE (3) COPIES. KEEP ONE (1) AND BRING TO CONFERENCE.
MAIL TWO (2) COPIES WITH $30.00 CREDENTIAL FEE TO:
KPC LA STATE CONFERENCE
c/o Lady Cheryl Flotte
P.O. Box 52853
New Orleans LA 70152
(504)373-1498
PLEASE PRINT OR TYPE ALL INFORMATION
CREDENTIALS DEADLINE IS May 1, 2014.
NO ON-SITE CREDENTIALS WILL BE ACCEPTED. NO EXCEPTIONS!
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2014 Jr. Louisiana State Conference Committee Choices
Please read carefully the Duties of Committees of the LA Jr. State Conference. Select one (1) committee
on which you would enjoy working and fill out the information below. Return this form with your
credentials by May 1, 2014. Your timely return will enable us to make assignments and hopefully let you
know which committee you will be working on prior to the Conference. Delay in returning information on
time may result in Branch/Court not being listed in agenda booklet.
Awards: This is a JOINT committee that will report to the body any suggestions on was to award and recognize juniors.
By-laws & Constitution Committee: This committee is designed to review and revise the Juniors State By-laws.
Charity: This is a JOINT committee that will present to the body, charitable ideas/activities the Jr. Members of Knights of Peter
Claver – Louisiana can do during the Jr. Conference and throughout the year as a group.
Credentials: This committee is responsible for getting the tally of the Jr. Conference voting strength. Credentials should be
reviewed. Delegates not present will not be counted. Only alternate delegates to the delegates should be counted. Permission
should be granted by the body to seat someone else from the court.
Dress Code: This committee will review the current Dress code of the Louisiana Jr. State Conference and make
recommendations to the body.
Emerging Leaders: This is a JOINT committee that will report to the body the activities of the Emerging Leaders. This
committee will also come up with ideas that will assist the Juniors in the transition from the Jr. to the Sr. Division.
Fundraising: This is a JOINT committee that will present to the body fundraising ideas that will replenish the Jr. State
Conference Funds for the Jr. Knights and Jr. Daughters. The committee will also make a financial report in the future on any
fundraising activities that were previously done for the Jr. State Conference fund.
Guards: This committee is responsible for taking the password at the entrance of the meeting chamber and receiving urgent
messages to be given to the president. Guards are to work closely with the Jr. State Mistress at Arms to make sure everyone
adheres to the dress code before entering the meeting chamber and that order is maintained during the meeting sessions.
Highlights & Evaluation: From the beginning of the conference to the close of the conference, this committee should list the
high and low points of the conference and vote for or against and state the reason for doing so.
Nominations/ Election: This committee will carry out the nomination and election process. Any junior seeking a State office
cannot serve as a member of this committee.
Programming & Planning: This committee was designed to create new activities or programs for juniors to participate in
during the conference. This committee will also select a Theme for next year’s conference from the entries submitted to the
Director/Directress. This is a JOINT committee.
Sickle Cell: Monies should be reported by KPC Districts (I-VII). The top three units (Branches or Courts) should be
recognized. This is a JOINT Committee.
Steering: This committee will review the rules for the order of the conference and make any recommendations/changes if
necessary.
Technology: This is a JOINT committee that will present to the body ideas that will enhance our Jr. Conference by utilizing
today’s technology. The committee can present ideas that will assist with registration, credentials, voting, etc. This committee
will review all Slideshow Competition Entries.
Time & Place: This is a JOINT committee. Since the conferences and state picnics are rotated by districts, this committee will
only present a report which states the date, city and place of the next Jr. Conference and State Picnic. The Director/Directress
will provide the information to the committee.
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What’s the Scoop Newsletter: This committee will work with the Conference Reporter to summarize the events of the Jr. KPC
Conference Weekend. The newsletter will be published via email at the Close of the Conference.
**********************************************************************************************************
Branch/Court Name ____________________________________________________ #__________ District ____________
Jr. Grand Knight/Jr. Grand Lady Name
1st Choice ____________________________________
____________________________________________
2nd Choice ____________________________________
3rd Choice_____________________________________
1st Delegate’s Name
1st Choice ____________________________________
____________________________________________
2nd Choice ____________________________________
3rd Choice_____________________________________
2nd Delegate’s Name
1st Choice ____________________________________
____________________________________________
2nd Choice ____________________________________
3rd Choice_____________________________________
Commander/Counselor Name
1st Choice ____________________________________
____________________________________________
2nd Choice ____________________________________
3rd Choice_____________________________________
Additional Membership Selections
Name: ________________________________________________
Choice: ______________________________________
Name: ________________________________________________
Choice: ______________________________________
Name: ________________________________________________
Choice: ______________________________________
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Candidates Profile and
Permission Form
Any member aspiring for a State Office must complete and return the form on or before May 1, 2014.
Junior Name:
Unit:
Unit Number:
Address:
City:
State: LA
Telephone Number:
Age:
Zip Code:
Email Address:
Years as a Junior:
Position Aspiring for:
This is to certify that the above named junior is in good financial standing with their branch/court
___________________________________________
Junior Grand Knight/ Lady
__________________________________________
Commander/Counselor
This is to certify that I give my son/daughter permission to run for a State Office, in the Junior
Knights/Junior Daughter Division of the Knights of Peter Claver, Inc.
Parent Name:
Parent Signature
Date
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To all Commanders/Counselors:
Please complete this form and return to the address listed below.
Branch/Court Name_________________________________________ #___________ District _______
City/State: ______________________________________________________________________________
Commander/Counselor:
Name___________________________________________________________________________________
Address_________________________________________________________________________________
City/State/Zip: ____________________________________________________________________________
Telephone (_________) _____________________________________________________________________
Email Address: ____________________________________________________________________________
Asst. Commander/Counselor:
Name___________________________________________________________________________________
Address_________________________________________________________________________________
City/State/Zip: ____________________________________________________________________________
Telephone (_________) _____________________________________________________________________
Email Address: ____________________________________________________________________________
Jr. Grand Knight/Lady:
Name___________________________________________________________________________________
Address_________________________________________________________________________________
City/State/Zip: ____________________________________________________________________________
Telephone (_________) _____________________________________________________________________
Email Address: ____________________________________________________________________________
Sr. Grand Knight/Lady:
Name___________________________________________________________________________________
Address_________________________________________________________________________________
City/State/Zip: ____________________________________________________________________________
Telephone (_________) _____________________________________________________________________
Email Address: ____________________________________________________________________________
Jr. Knights:
Brother Harold Narcisse
3578-A Main Hwy
Breaux Bridge, LA 70517
(337) 332-1169 or (337) 789-4624
Jr. Daughters:
PLEASE PRINT OR TYPE ALL INFORMATION!
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Lady Cheryl Flotte
P. O. Box 16517
New Orleans, LA 70152
(504)373-1498
53rd Louisiana
Jr. KPC State Conference
June 20th -22nd, 2014
Ramada Inn – Lafayette, LA
2014 Jr. Conference Photo Booth
Come by the
Jr. State Conference Photo Booth
to capture your memories of this Grand Event.
Pictures: $7.00
Individual and Group Photos will be taken before and during the Gala on
Saturday, June 21st
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2014 Jr. Conference
On-site Claver Community
Charity Project
Join us in contributing to our
On-site Baby Shower!!!
Every unit is asked to
bring an un-wrapped gift
to be donated to a local charity
in the District III area!
Remember your Christian Charity
and help us make this event successful!
Drop-off all items at the Information Desk by 9 a.m. on
Saturday, June 21st.
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