Aktion Club Disaster Relief Project Completion Form
Complete the following to request the New York District Disaster Relief Project Banner Patch
Email address *
Aktion Club Name *
Contact Name (First, Last) *
Street Address *
City, State, Zip *
Kiwanis Division *
Kiwanis Sponsor Club *
Phone number
Number of Disaster Relief Kits Completed *
Date of Completion *
MM
/
DD
/
YYYY
Additional Comments
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