District 55 Credentials Confirmation Form

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Please complete this form as either a club representative or a district leader. You can complete this form multiple times.

Please fill in your name *

Question 1: Are you completing this form as club representative or as a district leader? You will be asked for more information about your answer after this question.

Club Representative

District Leader

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If you answered Club Representative, please fill in the club name and number.

(Skip this if you answered question 1 "District Leader").

Are you President or Vice President Education of this club, or representing both?

(Skip this if you're a District Leader).

President

Vice President Education

Representing Both

Clear selection

Are you a District Leader? If so, please fill in your role.

(Skip this if you're a Club Representative).

Are you attending the District Council Meeting .... *

In Person

On Zoom

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