Distinguished Members Recognition

"*" indicates required fields

Kiwanis Club*

Division*

Name of Recipient*

1) Sponsor at least one new member (must still be a member in good standing September 30)

Name of Member Sponsored (or Recruited)*

Date Member Joined*

2) Complete at least three Interclubs (one must be with one of your Service Leadership Program clubs)

Club Visited

Date of Interclub

Club Visited

Date of Interclub

Club Visited

Date of Interclub

3) Participate in a service project with one of your Service Leadership Program clubs or actively serve as a regional member of a District committee.

Name of Project/Committee

Date of Project

4) Participate in at least one club social activity.

Name of Activity

Date of Activity

5) Attend at least two Kiwanis activities at the Division (Council Meeting), District (Midyear/Convention) or International (Convention) Level

Name of Activity

Date of Activity

Name of Activity

Date of Activity

6) Make a financial contribution this year to either the Capital District Kiwanis Foundation or Kiwanis Children's Fund.

Date Contribution Sent

Certification*

I hereby certify that the above listed member has completed all activities required for recognition

Name of Club Officer Certifying*

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