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.

CERTIFICATION OF DELEGATES AND ALTERNATES

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

This field is for validation purposes and should be left unchanged.
Name of Club Officer Reporting(Required)

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 Radisson Hotel in Lansing, MI on August 29, 2026.
Name
Delegate #1
Name
Delegate #2
Name
Delegate #3

Alternate Delegates

The names listed below have been elected as alternate delegates
Name
Alternate Delegate #1
Name
Alternate Delegate #2
Name
Alternate Delegate #3
Is your Lt. Governor a member of your club?
Is your Lt. Governor NOT a member of your club and elected to represent your 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
2025-26 President Name
2025-26 Secretary Name
Clear Signature
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