Fillable Optimist International Award Certi?cation Document

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Optimist International Award Certi?cation Document

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Award Cerficaon Document
_________________________
CLUB NUMBER
I , _________________________________________________________________________ PRESIDENT
PRESIDENT OF CLUB
OPTIMIST CLUB OF ____________________________________________________________________
NAME OF CLUB
DO HEREBY CERTIFY THAT OUR CLUB HONORED
_________________________________________________________________________ WITH A
NAME OF CLUB MEMBER OR LOCAL COMMUNITY INDIVIDUAL
_________________________________________________________________________ ON
TYPE OF HONOR OR AWARD
_________________________
DATE OF PRESENTATION
SIGNED
________________________________________________________ _________________________
CLUB PRESIDENT DATE
If your Club is located in Canada, please mail this completed form to the Canadian Service Centre,
Optimist International, 5205, boul. Metropolitain Est, bureau 200, Montreal, QC H1R 1Z7.
Attn: Beatrice Rossignol or e-mail rossignolb@optimist.org
If your Club is located in the USA or Caribbean, please mail this completed form to Optimist International,
4494 Lindell Blvd St. Louis, MO 63108.
Attn: Jackie Moore or email moorej@optimist.org | Fax (314) 371-6006
To report your service projects, click on the Club Pride Report link at:
http://www.optimist.org/Forms/Club_Pride_2017-2018.pdf
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Optimist International Award Certication Document

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Completed 29 January 2020

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