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 2021-2022

Club Officers for 2021-22 (term beginning October 1, 2021)
  • Formerly known as club billing contact
  • 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. Mail or email a copy of this form to your District Governor. 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