Please submit new officers following election. List the current mailing address, telephone contact numbers, and email address for each officer.

This form is due to World Headquarters by September 30th for your club to be in good standing for the 2026-2027 year. 

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 2026-2027

This field is for validation purposes and should be left unchanged.

Executive Officers

All four required for Club In Good Standing per CIP 0304 (officers may serve in more than one role)
CLUB PRESIDENT Name
President Mailing Address
CLUB PRESIDENT-ELECT Name
President-Elect Mailing Address
CLUB SECRETARY Name
Secretary Mailing Address
CLUB TREASURER Name
Treasurer Mailing Address
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.
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)
(Only names and email addresses will be shared for partnership contact purposes. Home addresses will never be shared.)

International Dues Billing

International Dues Billing Statements should be mailed to:(Required)
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.,)?(Required)
This should NOT be a member's personal or home address.
If you answered yes above, please enter the club's address here:
This should NOT be a member's personal or home address.

Additional Officers

Not required for Club In Good Standing
Public Relations Chair
Social Media Chair Name
Coin Box Chair Name