2009-10 Distinguished Member Form
To qualify, club members must complete the following:
* Required field
New Member: *  
New Member: *  
Distinguished Members will receive a lapel pin and recognition at the 2011 Kiwanis International Convention. (Deadline: October 15, 2010)
Distinguished Member: *  
Member ID#: *  
Club Name: *  
Club Key#: *  
Division: *  
District: *  
The Club President must verify members that qualify for Distinguished Member.
President’s Name: *  
President's E-mail Address (must be working address): *  
Submitted By: *  
Submitter's E-mail: *  

 

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