Governor-Nominee Designate Form
Full Candidate's Name
*
First Name
Last Name
Member, Rotary Club of
*
Candidate's Email
*
example@example.com
Candidate's Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Year Candidate Served as Club President - response should include the start year and end year, e.g. 2016-2017
*
Does the Candidate meet the criteria to be District Governor Nominee as stated in the email announcement?
Yes
No
Submit
Should be Empty: