District Trustee Report of Election

Report of Election

Complete and submit within 72 hours of the election.

This field is for validation purposes and should be left unchanged.

Term as District Trustee:

Name:

First Last

Club

Division:

Region:

Spouse/Partner's Name:

First Last

Name as you would like it to appear on your name badge and in the directory:

First Last

Name as your spouse/partner would like it to appear on their name badge and in the directory:

First Last

Preferred Mailing Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

(It should be a street address, not a post office box number, to receive packages from the District and Kiwanis International quickly and economically).

Home Phone:

Cell Phone:

Business Phone:

Email Address:

Occuption

Served as a Cal-Nev-Ha District Lt. Governor

Division(s) Year(s)

Other Positions held in Division, District or International:

Position Title(s)

Number of years in Kiwanis Membership:

Date First Joined Kiwanis:

Held Kiwanis Membership in Following Club's: (Give Dates if possible)

Check if you have Life Member Status?

District

International

Kids Need Kiwanis

District Trustee Report of Election

Report of Election