CERTIFICATION OF DELEGATES AND ALTERNATES

This delegate form must be signed by both the club president and secretary. Forms not signed by both officers will be returned for completion. It is not the option of the secretary to sign for the president or vice-versa. No forms will be available at Great Lakes Conference.

To the 109th Annual Great Lakes Conference

in Lansing, Michigan on August 29, 2026

2026 GLC Club Delegate Form

Club Delegates and Alternates certification form

Phone

This field is for validation purposes and should be left unchanged.

Name of Club Officer Reporting(Required)

First Last

Phone(Required)

Email(Required)

Club Officer

Club Name

Club Delegates

The following names are the duly elected Delegates of this club for the 109th Annual Great Lakes Conference of the Michigan District of Kiwanis International, to be held at the Crowne Plaza Hotel in Lansing, MI on August 29, 2026.

Name

Delegate #1

First Last

Name

Delegate #2

First Last

Name

Delegate #3

First Last

Alternate Delegates

The names listed below have been elected as alternate delegates

Name

Alternate Delegate #1

First Last

Name

Alternate Delegate #2

First Last

Name

Alternate Delegate #3

First Last

Is your Lt. Governor a member of your club?

We understand that if our current Lt. Governor is a member of our club, they are a Delegate-At-Large and do not need to be listed on the form.

Is your Lt. Governor NOT a member of your club and elected to represent your club?

We understand that if our current Lt. Governor is NOT a member of our club, they can represent our club per the form below. We verify that our club has asked out Lt. Governor representative to vote on our behalf and the Lt. Governor has agreed to represent our club

Lt. Governor Representation Certification

When completed, this form certifies the above listed Club will be represented by the Current Lt. Governor or a Past Lt. Governor in this Division, as one of our three (3) elected delegates. Clubs are encouraged not to name a 2025-26 Lt. Governor, Lt. Governor-Designate, a District Chair, or a past District Governor who is a member of your club as either a delegate or alternate a they can vote as a Delegate-At-Large.

Name

First Last

Year Served

Division

2025-26 President Name

First Last

2025-26 Secretary Name

First Last

Signature(Required)

Aktion Club Convention

Aktion Club Convention

September 25, 2026

4:00 pm - 5:00 pm

Camp Henry, 5575 S Gordon Ave, Newaygo, MI 49337, USA

Click here for more info

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25 Sep
Circle K Fall Rally

Circle K Fall Rally

November 08, 2026

12:00 am - 11:59 pm

Michigan State University, East Lansing, MI, USA

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08 Nov
Circle K Snowpia

Circle K Snowpia

January 30, 2027

12:00 am - 11:59 pm

(Location TBA)

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30 Jan
Circle K District Convention

Circle K District Convention

March 06, 2027

12:00 am - 11:59 pm

University of Michigan-Dearborn, 4901 Evergreen Rd, Dearborn, MI 48128, USA

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06 Mar

CERTIFICATION OF DELEGATES AND ALTERNATES