2016-2017 Club Service Award

October 1, 2016 to June 30, 2017

This award is for all clubs who qualify by doing service projects during the year.  A special banner patch will be awarded at the following District Convention 2017.  Form must be mailed to District Office by July 14, 2017.

To quality for the Service Patch, a club must complete the following criteria:

Completed two (2) service projects - list below.     Yes ___   No ___

Describe and name the project:

1.  _____________________________________________________________________


2.  ______________________________________________________________________


Completed a new club service project.              Yes ___   No ___

What was the new project?


Completed a service project with SLP.     Yes ___   No ___

What was the SLP project?


If your club does not sponsor a SLP, did you:
*Contribute 75.00 to the district for SLP?            Yes ___    No ___


Inter-club with another club on their SLP service project?       Yes ___   No ___

What was the SLP project?


I certify the above information for the ___________________________Club in Division ____________
                                                                                    (name of club)                                                              (1-18)

Signature of President __________________________________________

*This contribution is sent to the District Office.  Patch is awarded to club by mail.

Please return signed form to:   KT District Office  1035 Strader Dr. Suite 150, Lexington, KY 40505
or email to:  ktdistrict@kytnkiwanis.org

form for 2016-17 Club Service Award