Lt. Governor Elect Acceptance Form

Lt. Governor Elect Acceptance & Contact Information Form

Lt. Governor Elects (or appointees) are asked to complete this form that acknowledges duties and provides contact information. This form is submitted to the district office. (Lt. Governor Assistants are also asked to complete this form.)

Name(Required)

First Last

Name of Primary Club(Required)

Division No.(Required)

Did your division hold a lt. governor election?

yes

no (if no election, District Board will appoint)

Will you be serving as…

lt. governor

lt. governor assistant

By signing below, I hereby give my consent to having my name placed in nomination for the office of Lieutenant Governor of the stated division in the Nebraska-Iowa District of Kiwanis International for the upcoming administrative year and agree, to the best of my ability, to carry out my duties as prescribed in the District Bylaws and Policies.

I will make every effort to attend the following events, either in person or virtually: • Governor-elect Training/Organization Conference for Lt. Governors-elect; .• The District Midyear Conference and/or Leadership Development Conference; • My Divisional Conference, which I will organize and hold to elect a successor; •Club Leadership Education/Training for club officers of my division; • District and/or International conventions; • Other educational and training opportunities as offered; • At least two regular meetings of each club in my Division, and more regular or special meetings I deem necessary to best serve the clubs. I will also attend and report on one Board meeting of each club.

I understand that some, but not all, expenses in connection with my duties as Lieutenant Governor will be covered by district funds.

I also understand while serving in this position it is a District requirement that I maintain a clear background check through the Kiwanis approved vendor.

Signature(Required)

Date(Required)

I have served as a Kiwanis Club President or feel that other Kiwanis service has made me equally qualified in Kiwanis leadership. Here is a resume of my Kiwanis service:(Required)

(Include year(s) of club president; any district service: other club or district offices, committee chairs or service)

Other Information Relevant To Nomination

Please complete as you would like it to appear on business cards and district directory:

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

(If you have a PO mailing box, please also include physical street address)

Email(Required)

Primary Phone(Required)

Kids Need Kiwanis

Lt. Governor Elect Acceptance Form

Lt. Governor Elect Acceptance & Contact Information Form