Report of Civitan Club Officers
Club Officers for 2017-18 (term beginning October 1, 2017)
Return no later than July 1, 2017
Secretaries: Please complete this form and mail it immediately following club officer elections. List the member number, current mailing
address, telephone contact numbers (with area code), and email address (when available) for each officer. If officers are not reported, last
year’s officers will be used for contact purposes and listed in the international directory.
District #
Club Name
Club #
Club Meeting Location
Street address
City
Club Meets
State/Province
Each Week
Club’s Membership
Postal Code
1-3 week
2-4 week Day of Week
Male
Female
Time
a. m.
p. m.
Both
Club Mailing Address:
President
Member Number
Mailing Address
City
Area Code
State/Province
(B)
(R)
Postal Code
(Cell)
Fax
Email
President-Elect
Member Number
Mailing Address
City
Area Code
State/Province
(B)
(R)
Postal Code
(Cell)
Fax
Email
Secretary
Member Number
Mailing Address
City
Area Code
State/Province
(B)
(R)
Postal Code
(Cell)
Fax
Email
Treasurer
Member Number
Mailing Address
City
Area Code
State/Province
(B)
(R)
Postal Code
(Cell)
Fax
Email
Billing Contact
Member Number
Mailing Address
City
Area Code
State/Province
(B)
(R)
Postal Code
(Cell)
Fax
Email
1. Mail, fax or email original to:
Civitan International Records Dept.
P. O. Box 130744
Birmingham, AL 35213-0744
Fax: 205-592-6307
Email: [email protected]
2. Mail a copy to: your District Governor-Elect
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Report of Civitan Club Officers (page 2)
District #
Club #
Club Name
Public Relations Chair
Member Number
Mailing Address
City
State/Province
Area Code
(B)
(R)
Postal Code
(Cell)
Fax
Email
Webmaster
Member Number
Mailing Address
City
State/Province
Area Code
(B)
(R)
Postal Code
(Cell)
Fax
Email
Club Fund Raising Chairs for 2017-18 term beginning October 1, 2017)
Candy Box Chair
Member Number
Mailing Address
City
Area Code
State/Province
(B)
(R)
Postal Code
(Cell)
Fax
Email
Fruit Cake Chair
Member Number
Mailing Address
City
Area Code
State/Province
(B)
(R)
Postal Code
(Cell)
Fax
Email
Coin Box Chair
Member Number
Mailing Address
City
Area Code
State/Province
(B)
(R)
Postal Code
(Cell)
Fax
Email
Med-A-Vend Chair
Member Number
Mailing Address
City
Area Code
State/Province
(B)
(R)
Postal Code
(Cell)
Fax
Email
1. Mail, fax or email original to:
Civitan International Records Department
P. O. Box 130744
Birmingham, AL 35213-0744
Fax: 205-592-6307
Email: [email protected]
2. Mail a copy to: your District Governor-Elect
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