2024 District Convention Delegate Certification
Note: This form does not constitute a convention registration.
Deadline: August 2

District House of Delegates: Provision is made for the election of delegates and alternates in accordance with Article VI, Sec. 6 of the District Bylaws. Certificates must be signed by the Club President and Secretary. Each chartered club in good standing shall be entitled to three (3) delegates to the convention’s house of delegates. Two (2) of the delegates should be the club presidentand president-designate (if at all possible). There is no voting by proxy or absentee ballot.
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Club Name *
Submitter's Name and Title (for example:  Jane Doe, Club Secretary)
Delegate # 1 Name and Title
Delegate # 2 Name and Title
Delegate #3 Name and Title
Alternate # 1 Name and Title
Alternate #2 Name and Title
Alternate #3 Name and Title
Other Representatives
Only use this area in the event your club is unable to assign club members as delegates and/or alternates at the Convention. 
According to Article 6, Section 6 of the District Bylaws, you are permitted to have your current Trustee, Lt. Governor, any past Lt. Governor residing in your Division or your District Secretary to represent your club for voting purposes at the District Convention’s House of Delegates in the event your club is unable to have its own club members in attendance. 

Therefore, if your club is intending to have other representation, firstly - seek permission from them to represent you and then identify them in the area provided.
Other representative & Title
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