Before completing this form, ensure that all club officers review the Licensing Agreement and Protecting Vulnerable Communities Handbook, linked below. You will be asked to accept both on behalf of your club. 

Click Here to View Licensing Agreement

Click Here to View Protecting Vulnerable Communities Guidebook

Newly Chartered Club Compliance Submission

Name(Required)
Have your club leaders reviewed Civitan International's Protecting Vulnerable Communities Guidebook, and do you accept its terms on behalf of your club?(Required)
(Link to download and review at the top of this page.)
The Civitan brand is trademarked and the property of the organization. To protect the organization and its brand, Civitan International requires a formal agreement by any entity using the Civitan brand. Have your club officers reviewed this agreement and do you accept on behalf of your Civitan club?(Required)
(Link to download and review at top of this page.)
On behalf of the club's board, do you agree that the contact information of the four executive officers may be shared with strategic partners of Civitan International, only for the purposes of furthering the Civitan International mission?(Required)
(Name and email only. Home addresses will never be shared.)
To maintain compliance with its Internal Revenue Service (IRS) group exemption, Civitan International is required to annually submit a list of active subordinate organizations (clubs), including current contact information. This authorization permits Civitan International to include your club in this filing.(Required)
On behalf of the club’s board of directors, and pursuant to applicable law, by selecting "Yes" below, our club consents to the inclusion of the club’s name, identifying information, and contact details in Civitan International’s annual IRS CP119 filing.