Elections and Delegate Form (Clubs Inside North America)

2023 Elections & Delegates Form : Clubs Inside North America

This form is for Club Presidents for clubs within North America to notify Civitan International who your voting delegates will be at the 2023 Civitan International Convention.

Club Name*
Please select your club from the options below.
Name of Person Completing Form*
First Last
Email of Person Completing Form*
Phone Number of Person Completing Form*
I understand only a Club President should complete this form on behalf of a club, and certify that I am the President of the Civitan Club for which this form is being completed.*
- I am this club's President
How many voting delegates is your club allowed?*
Voting Delegate 1
First Last
Voting Delegate 1 Email
Voting Delegate 1 Phone Number
Voting Delegate 2
First Last
Voting Delegate 2 Email
Voting Delegate 2 Phone Number
Voting Delegate 3
First Last
Voting Delegate 3 Email
Voting Delegate 3 Phone Number
Voting Delegate 4
First Last
Voting Delegate 4 Email
Voting Delegate 4 Phone Number
Voting Delegate 5
First Last
Voting Delegate 5 Email
Voting Delegate 5 Phone Number
Voting Delegate 6
First Last
Voting Delegate 6 Email
Voting Delegate 6 Phone Number
Voting Delegate 7
First Last
Voting Delegate 7 Email
Voting Delegate 7 Phone Number
Voting Delegate 8
First Last
Voting Delegate 8 Email
Voting Delegate 8 Phone Number
Voting Delegate 9
First Last
Voting Delegate 9 Email
Voting Delegate 9 Phone Number
Voting Delegate 10
First Last
Voting Delegate 10 Email
Voting Delegate 10 Phone Number

Elections and Delegate Form (Clubs Inside North America)

2023 Elections & Delegates Form : Clubs Inside North America

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