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2011-12 Distinguished Member Form |
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DEADLINE: October 15, 2012 |
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To qualify, club members must complete the following:
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* Required field |
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New member:
*
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New member:
*
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Bonus activities that show a commitment to excellence:
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Distinguished Members will receive a lapel pin and recognition.
DEADLINE: October 15, 2012
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Distinguished member:
*
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Member ID#:
*
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Club name:
*
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Club key#:
*
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Division:
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District:
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The Club President must verify members that qualify for Distinguished Member.
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President’s name:
*
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President's email:
*
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(Must be valid address)
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Submitted by:
*
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Submitter's email:
*
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