Fillable INTERNATIONAL BOARD MEMBER (Optimist International)

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INTERNATIONAL BOARD MEMBER (Optimist International)

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76
Junior Opmist Internaonal Applicaon for Internaonal Oce and
Biographical Release
Qualified Members are invited to submit this form stating their intention to run for office.
Please submit your speech no later than June 15, to Optimist International so that it can be
translated for Convention.
APPLICATION DEADLINE: June 15
Please submit application and copy of campaign speech no later than June 15
(speech will be translated).
Position Campaigning for:
Director
President
Candidate’s Name: _______________________________________________________________________
(Last) (First)
Address: _______________________________________________________________________________
City: ________________________ State/Prov: ____ ZIP/Postal Code: __________ Country: _______
Telephone: ( ______ ) ____________________ Fax Number: ( ______ ) ___________________________
E-Mail Address: _________________________________________________________________________
Club Name: _____________________________________________________________________________
Club #: __________________________________________ District #: _____________________________
Name of School Attended: ________________________________________________________________
Year in School as of October 1: _____________________ Date of Birth: _________ / _______ / _______
Advisor’s Name: _________________________________________________________________________
List qualifications, offices held, activities and what you hope to accomplish if elected:
Signature: ___________________________________________ Date: ______ / ______ / ___________
IMPORTANT: A CLEAR, REPRODUCIBLE PHOTO MUST ACCOMPANY THIS APPLICATION!
*For additional forms that must accompany this application, visit junioroptimist.org.
Send Application & Photo To:
Optimist International
Junior Optimist Department
4494 Lindell Boulevard
Saint Louis, MO 63108
Fax: (314) 371-6006
youthclubs@optimist.org
INTERNATIONAL BOARD MEMBER
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INTERNATIONAL BOARD MEMBER (Optimist International)

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Completed 30 July 2020

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