PGI Recognition Form
Name of Club: _____________________________________ Club Number: _____________
Name of Member Member # Level Date
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Certied by:
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President’s signature (Levels I – VII) OR Secretary-Treasurer’s signature (Levels I – VII)
President’s signature (Levels VIII – X) OR Lieutenant Governor’s signature (Levels VIII – X)
THIS FORM MUST BE SENT BY THE ABOVE CERTIFYING OFFICIAL
TO THE DISTRICT DIRECTOR OF PERSONAL GROWTH
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