Club Officers: Requests & Updates

Requesting Club Officer

Club member adds, deletes and contact information changes submitted after 2:00 p.m. central on June 28 will be recorded on or after July 2, 2019.

Request Submitted By:*
First Middle Last
Street Address City State ZIP Code
*
If you no longer have a home phone number or do not have a cell phone, please enter N/A in the appropriate field.
Home Phone Cell Phone Email
My Club*
My Club Officer Position
Request Information
Information will be emailed to you within two business days.
Please send the following ...
To select more than one option, hold down the Ctrl key (PC) or CMD key (MAC) and click on each applicable choice. In case of an accidental selection, continue to press the Ctrl/CMD key and click on the entry you wish to deselect. When selection is complete, release the Ctrl/CMD key.
Additional Request for Information
Please provide a brief description of your request. Requests for additional information must be submitted for review. After the review process is complete, you will be notified through the email address listed above regarding approval and/or availability of the requested information.
Please consider this request for the following information that falls outside of the options previously listed.
Club/Member Updates
I want to ...
To select more than one option, hold down the Ctrl key (PC) or CMD key (MAC) and click on each applicable choice. In case of an accidental selection, continue to press the Ctrl/CMD key and click on the entry you wish to deselect. When selection is complete, release the Ctrl/CMD key.
Add Member(s)
Quantity of New Members*
Select the number of new members you will be adding. To add more than five, please split the list and repeat the submission process.
New Member #1
First Name Last Name Date of Birth Recruited By
Street City State Zip
Home Phone Cell Phone Email
New Member #2
First Name Last Name Date of Birth Recruited By
Street City State Zip
Home Phone Cell Phone Email
New Member #3
First Name Last Name Date of Birth Recruited By
Street City State Zip
Home Phone Cell Phone Email
New Member #4
First Name Last Name Date of Birth Recruited By
Street City State Zip
Home Phone Cell Phone Email
New Member #5
First Name Last Name Date of Birth Recruited By
Street City State Zip
Home Phone Cell Phone Email
Delete Member(s)
Delete Member(s)
Please enter all requested information for each individual to be removed from the club's roster. To remove more than one club member, click the small plus sign at the end of the row. A new row will be added for the additional removal.
First Name Last Name Street City State Zip
Reason for Deletion*
Date Deceased
If unknown, leave blank.
Date Format: MM slash DD slash YYYY
Update Member(s) Contact Information
Update Member Information
Please enter the new information for each member. To submit changes for more than one club member, click the small plus sign at the end of the row. A new row will be added for the additional information change.
First Name Last Name Street City State Zip Home Phone Cell Phone Email
Change Meeting Location
Change Meeting Details
Please enter all requested information to ensure accurate location of meeting location pin on Find A Club map.
Business/Building Proper Name Full Street Address City State Zip Meeting Time (please indicate a.m. and p.m. Meeting date(s) Meeting Frequency

Club Officers: Requests & Updates

Requesting Club Officer

Request Information

Additional Request for Information

Club/Member Updates

Add Member(s)

Delete Member(s)

Update Member(s) Contact Information

Change Meeting Location

Sertoma Success

2017-18 Sertoma Community Grant Recipient

2017-18 Communicative Disorders Scholarship

2017-18 Hard of Hearing or Deaf Scholarship

First Name	Last Name	Street	City	State	Zip	Home Phone	Cell Phone	Email

Business/Building Proper Name	Full Street Address	City	State	Zip	Meeting Time (please indicate a.m. and p.m.	Meeting date(s)	Meeting Frequency