Certification of Election of Delegates and Alternates to the 2013 Circle K International Convention

Only dues-paid members of clubs in good standing (having paid for at least 15/10 members), as verified by the Circle K club, are eligible to be convention delegates. Club delegates should be elected by May 15, 2013. If a club member is not able to represent the club, the club may vote to have the current or immediate past lieutenant governor for the division or any other current district officer represent the club’s voice to the House of Delegates. Certification of representation by a district officer should be demonstrated below. This is to certify that the following individuals are duly elected delegates and alternates to represent the Circle K of:



DELEGATE 1 INFORMATION








DELEGATE 2 INFORMATION








ALTERNATE DELEGATE 1 INFORMATION








ALTERNATE DELEGATE 2 INFORMATION








ELECTRONIC SIGNATURE OF CLUB PRESIDENT OR SECRETARY

The signature below verifies the above-named delegates as dues-paid members of the club, with the exception of district officer representation whose membership will be verified separately, and certifies that these individuals have been elected to represent the Circle K club noted above





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