Region 3
Delegate Certification Form - Trustee Election 2025
This form is for delegates in Region 3
Club secretaries in Region 4 please provide delegate information by April 9, 2025.
Each club is entitled to two votes:
The president and the immediate past president are the assigned delegates, but may designate another member(s) of the club to serve as a delegate in their absence.
*
Kiwanis Club of (name of club)
(Required.)
*
Club Number K-
(Required.)
*
Division
(Required.)
3
4
5
6
Delegate 1
Name of Club President (or other desingated delegate)
Member K-Id Number:
Delegate 1 Email Address:
Mailing Address
City
State
NE
IA
Zip:
Delegate 2
Name of Immediate Past President (or other designated delegate):
Member K-Id Number:
Delegate 2 Email Address:
Mailing Address
City
State
NE
IA
Zip:
*
Club Secretary Name:
(Required.)
*
Club Secretary's Email:
(Required.)
Submitted by: (if submitted by someone other than club sectary)
Club office:
