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OFFICER ELECTION REPORT
Ocer Informaon Sheet/Elecon Report
(Please print or type)
Club Name: ____________________________________________________________________________
Club #: _________________________________________________________________________________
Name of Sponsoring Optimist Club: _______________________________________________________
Club #: _________________________________________________________________________________
Club Adviser:
Name: o Mr. o Ms. _____________________________________________________________________
Address: _______________________________________________________________________________
City: ________________________ State/Prov: ____ ZIP/Postal Code: __________ Country: _______
Telephone: ( ______ ) ____________________ Fax Number: ( ______ ) ___________________________
E-Mail Address: _________________________________________________________________________
Optimist Serving as Chairman of Club Committee:
Name: _________________________________________________________________________________
Address: _______________________________________________________________________________
City: ________________________ State/Prov: ____ ZIP/Postal Code: __________ Country: _______
Telephone: ( ______ ) ____________________ Fax Number: ( ______ ) ___________________________
E-Mail Address: _________________________________________________________________________
Club Ocers: (Optional for Alpha Clubs)
President: ___________________________________________________________ Grade Level _______
Address: _______________________________________________________________________________
City: ________________________ State/Prov: ____ ZIP/Postal Code: __________ Country: _______
Telephone: ( ______ ) ____________________ Fax Number: ( ______ ) ___________________________
E-Mail Address: _________________________________________________________________________
Secretary/Treasurer: __________________________________________________ Grade Level _______
Address: _______________________________________________________________________________
City: ________________________ State/Prov: ____ ZIP/Postal Code: __________ Country: _______
Telephone: ( ______ ) ____________________ Fax Number: ( ______ ) ___________________________
E-Mail Address: _________________________________________________________________________
Possible Projects Discussed:
1. _____________________________________________________________________________________
2. _____________________________________________________________________________________
3. _____________________________________________________________________________________
