Fill out the form below and submit online. Name of ClubYear for which delegate is appointed *Year202420252026Delegate NameThis delegate is appointed to represent and take actions on behalf of the above named club.Email AddressPhoneDateDate signedPosition held in the club *PositionPresidentVice PresidentSecretaryI have authority to appoint a delegate on behalf of the above named clubName of Club OfficerEmail Address of Club Officer Send Delegate Form
