I certify that I have read and am familiar with the international bylaws and board policies. If elected to office, I will be governed by these provisions. I will not place myself in any position whereby there shall arise any direct or indirect conflict of interest with the duties of my office and that should such conflict occur, I immediately shall waive and relinquish my Civitan office.

I request the Executive Vice President to certify to the Civitan International Board of Directors and the Nominating Committee that I am a qualified candidate for this office in accordance with the governance documents of Civitan International.