Mid-Year Club Officer Change Form

Mid-Year Change of Club Officers

List the current mailing address, telephone contact numbers (with area code), and email address(es) for each officer change.

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 World Headquarters. You may also email to WHQ at forms@civitan.org.

After clicking submit, you should receive an email notification that includes all of the information you provided in this form. If you do not receive the confirmation email in a timely manner, please check your spam and junk folder(s). If you are having trouble, please email forms@civitan.org.

Civitan Year
Which year's officers are you making an update to?
Your Name*
First Last
Your Email*
Civitan Club Name*
Officer Changes
Please only enter the information for the officer position being updated, to the NEW officer's information.
President Name
First Last
President Email
President Phone
President Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
President-Elect Name
First Last
President-Elect Email
President-Elect Phone
President-Elect Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Secretary Name
First Last
Secretary Email
Secretary Phone
Secretary Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Treasurer Name
First Last
Treasurer Email
Treasurer Phone
Treasurer Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing Contact Name
First Last
Billing Contact Email
Billing Contact Phone
Billing Contact Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mid-Year Change of Club Officers

Mid-Year Club Officer Change Form

Officer Changes