Fillable Leadership Academy Recommendation Fillable (Optimist International)

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Leadership Academy Recommendation Fillable (Optimist International)

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RECOMMENDATION FOR LEADERSHIP ACADEMY CANDIDATE
Personal Information for Candidate
First Name: _______________________________ Last Name:_________________________________
Mailing Address:__________________________________________________________________________
City: ______________________________________ State/Providence:___________________________
Zip/Postal Code: ______________________ Country: __________________________________
Home phone: ____________________________ Work phone: ______________________________
Cell phone: _____________________________ Email address: _____________________________
Profession/occupation:________________________________________
Optimist Information
Club Name:____________________________________ Member Number:___________________________
Which year were they Club President? ____________ Distinguished? __Yes __No Honor? __Yes __No
Reason(s) for Recommendation:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Submitted by:______________________________________________ Date:___________________________________
Send to:
Optimist International
Attn: Leadership Development Committee
4494 Lindell Blvd., St. Louis, MO 63108
E-Mail: leadership@optimist.org
Fax: 314-735-4106
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Completed 23 July 2020

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