Club Officer Report Form 2024-2025 | Civitan International

Please submit new officers following election. List the current mailing address, telephone contact numbers (with area code), and email address(es) for each officer.

Click here to download a PDF version of this form. If you choose to complete the form using the PDF version, please mail a copy to Civitan International Headquarters. You may also email to WHQ at growth@civitan.org.

Report of Civitan Club Officers 2024-2025

Club Officers for 2024-25 (term beginning October 1, 2024)

Executive Officers

All four required for Club In Good Standing per CIP 0304 (officers may serve in more than one role)

Your Name(Required)

Your Email(Required)

Civitan Club Name(Required)

CLUB PRESIDENT Name

First Last

President Email

President Phone

President Mailing Address

Street Address City State / Province / Region ZIP / Postal Code Country

CLUB PRESIDENT-ELECT Name

First Last

President-Elect Email

President-Elect Phone

President-Elect Mailing Address

Street Address City State / Province / Region ZIP / Postal Code Country

CLUB SECRETARY Name

First Last

Secretary Email

Secretary Phone

Secretary Mailing Address

Street Address City State / Province / Region ZIP / Postal Code Country

CLUB TREASURER Name

First Last

Treasurer Email

Treasurer Phone

Treasurer Mailing Address

Street Address City State / Province / Region ZIP / Postal Code Country

Some or all of the officers listed above are living with I/DD, and request special accomodations for club officer training.

Check the box below if true, and the person completing this form will be contacted by the membership department. Please certify as the person completing this form, that you have communicated with these officers and they self-identify as living with I/DD, and request these accommodations. Traditional Club Officer Training is always available for any officer with I/DD who wishes to train in that way.

Yes

International Dues Billing

International Dues Billing Statements should be mailed to:(Required)

Club Treasurer

Club Secretary

Club President

Club PERMANENT Address (entered at bottom of this form)

Other

If you chose "other" or "Club PERMANENT Address" above, enter the club billing contact's name, address, email here:

Email is required for billing contact digital billing to be received.

Does the club have a PERMANENT club mailing address? (Physical clubhouse, P.O. Box, etc.,)?

This should NOT be a member's personal or home address.

Yes

If you answered yes above, please enter the club's address here:

This should NOT be a member's personal or home address.

Street Address City State / Province / Region ZIP / Postal Code Country

Additional Officers

Not required for Club In Good Standing

Public Relations Chair

First Last

Public Relations Email

Social Media Chair Name

First Last

Social Media Chair Email

Coin Box Chair Name

First Last

Coin Box Chair Email

Coin Box Chair Phone