Delegate Certification Form

Delegate Certification Form

Each Club is entitled to two (2) Delegates and (2) Alternate Delegates for the 2021 Southwest District Convention. This form is to be completed by a person authorized by the Key Club to certify the Club's Delegates (that may be the Advisor, the President, the Secretary, or another person designated by the Club).
The deadline for submitting a Delegate Certificiation Form is April 1st
Key Club Name
Division
if you are not sure of your Division, please consult the website at DIVISION LISTING | swd-key-club
Each Club should name two (2) Delegates.

The following sessions are REQUIRED for Delegates:
1. Their Division's Caucus (Sunday, April 11th between 4-8pm AZ / 5-9pm NM&TX)
2. An Executive Officer Caucus (Sunday, April 11th between 4-8pm AZ / 5-9pm NM&TX), and
3. Nominating Conference (Sunday, April 11th at 8pm AZ / 9pm NM&TX)
4. House of Delegates (Thursday, April 15th at 6pm AZ/7pm NM&TX) on.
Before naming Delegates and Alternate Delegates, please confirm they are committed to attending these three sessions.
Delegate #1 Name:

First NameLast Name
Delegate #1 Email (please use email NOT subject to school firewall):
example@example.com
Delegate #1 Phone:
Please enter a valid phone number.
Delegate #2 Name:

First NameLast Name
Delegate #2 Email (please use email NOT subject to school firewall)
example@example.com
Delegate #2 Phone:
Please enter a valid phone number.
In case a named Delegate's schedule changes and he/she is not able to attend the above require sessions, an Alternate Delegate can step in.

Each Club may designate two (2) Alternate Delegates.
Alternate #1 Name:

First NameLast Name
Alternate #1 Email (please use email not subject tot school firewall)
example@example.com
Alternate #1 Phone
Please enter a valid phone number.
Alternate #2 Name:

First NameLast Name
Alternate #2 Email (please use email not subject to school firewall)
example@example.com
Alternate #2 Phone
Please enter a valid phone number.
By signing below you certify the above listed Delegates (and Alternates if necessary) have been authorized to cast your Club's vote at the 2021 District Convention Caucus and House of Delegates, and you certify you have been authorized to issue this certification.
Signature

Clear
Name of Person Submitting Certification

First NameLast Name
Title of Person Submitting Certification
Email for submitter
example@example.com
Should be Empty: