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 World Headquarters and your District Governor. You may also email to WHQ at

Report of Civitan Club Officers 2022-2023

Club Officers for 2022-23 (term beginning October 1, 2022)

  • This should NOT be a member’s personal address.

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 folders. If you are having trouble, please email