Delegate Forms

Convention Delegate Form 2024

ELECTION CERTIFICATE FOR DELEGATES AND ALTERNATES TO THE NEBRASKA-IOWA KIWANIS HOUSE OF DELEGATES District Convention, Aug. 3, 2024, West Des Moines, Iowa

This is to certify the following members of the Kiwanis Club of:(Required)

In Division(Required)

and Region(Required)

Club No. K-(Required)

The duly elected delegates* of the club to the Aug. 3, 2024 District Convention House of Delegates are:

Delegate Name:

Member No.

Delegate Name:

Member No.

Delegate Name:

Member No.

Alternate Name:

Member No.

Alternate Name:

Member No.

Alternate Name:

Member No.

Date(Required)

Club President Name(Required)

First Last

Submitted by Club Secretary(Required)

First Last

Signature(Required)

Sign electronically in this space

*Note: Each club shall be entitled to seat up to three (3) delegates, two (2) of whom should be the club president and president‐elect (OR their designates) as well as nominate three alternates who may serve if any delegate is absent. Club delegates and alternates shall be active members of the clubs they represent. (The Lieutenant Governor or a past Lieutenant Governor may represent any club in their division not otherwise represented.) There is no voting by proxy. No club shall be considered in good standing to have a delegate that is delinquent in the payment of district or international dues or obligations. Each club should submit this form by July 26, 2024.

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Delegate Forms

Convention Delegate Form 2024