KEY CLUBŠ District of Jamaica REGISTRATION FORM This form must be returned with all the required signatures to the District Administrator no later than December 30, 2010 for Lieutenant Governor Candidates and for District Executive candidates. Failure to complete in full and return the service agreement will result in ineligibility to run for the post of District Board Member.
Office Sought: [ ] Governor [ ] District Secretary Treasurer [ ] District Bulletin Editor/Web Editor [ ] Lieutenant Governor [ ] Endorsement for International of Office In announcing myself as a candidate for the above named office, I hereby declare that: I am fully aware of the responsibilities that this office carries with it and I am confident that I will be able to fulfill all duties and obligations as stated in the service agreement for this office. I intend to remain in high school during the 2011-2012 school year. I will endeavor to maintain my schoolwork and not let this office have any adverse effect on my future education. I intend to remain an active member of my home key club and participate in as many projects as possible. I will set high standards for myself and at all times will strive to bring honour to my club and the Jamaica District of Key Club International I will abide by the rules set down by the Elections Committee of the Jamaica District.
PERSONAL INFORMATION
Last Name
Middle Initial
Home Address
Number and Street Name
_____________________________________________ Town _______________ Division
First Name
________________________________
Parish
Telephone Number
_____________________________________________________________
________________________ Office Currently Held (E.g. President) ___________________________________ Email Address
Home Club Name
Past Offices Held