PM
Club Officers Who Will Be Taking Office October 1, 20_ _
President-Elect
District Zone Club Number
Optimist Club of
Secretary-Elect
Treasurer-Elect
Name:
Address:
City:
Home Phone:
E-mail: Check if your address changed
Work Phone: Cell:
State: ZIP Code:
Sex: Male Female
Name:
Address:
City:
Home Phone:
E-mail: Check if your address changed
Work Phone: Cell:
State: ZIP Code:
Sex: Male Female
Name:
Address:
City:
Home Phone:
E-mail: Check if your address changed
Work Phone: Cell:
State: ZIP Code:
Sex: Male Female
Club Foundation Representative
Name:
Member Number
Member Number
Member Number
Member Number
Address:
City:
Home Phone:
E-mail: Check if your address changed
Work Phone: Cell:
State: ZIP Code:
Sex: Male Female
Complete Only If Changed
Name of meeting place:
Date of meeting: Time: AM
Weekly
Alternate Weeks 1st 2nd 3rd 4th 5thMeeting frequency:
Current Officer
Name:
Date:
Signature:
Distribution List
Optimist International, 4494 Lindell Blvd. Saint Louis, MO 63108 USA
or
Canadian Service Centre 5205 Metropolitan Blvd. East, Suite 200 Montreal, QC H1R 1Z7 Canada
Dist. Secretary/Treasurer
Date Revised: May 2018
Club Officer-Elect Report
Due:
May 20
This information may be completed and submitted online at www.optimistleaders.org
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