R.I. District 3170 District Governor Nomination Committee member Form:-

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R.I. District 3170 District Governor Nomination Committee member Form:-

Name of the District Governor Nomination Committee Member (DGNCM)of RI Dist. 3170 from

Rotary Club of _________________________________________

a) Regular candidate: _________________________________________________(as on SAR)

b) Alternate Candidate: ________________________________________________(as on SAR)

We, the President and the Secretary of the above mentioned Club hereby certify that our above candidate for DGNCM is:-

(i) a Rotarian in good standing in club(s) within the district for at least five years as on July 1 of the Rotary year 2012-13

(ii) served as president of a Rotary Club in the district for a complete term (Cut off which is not applicable)   or

served as charter president of a club having served the full term from the date of charter to June 30, provided that the period is at least six months,

(iii) is not a district governor, governor-elect, governor-nominee, past governor or assistant governor.

(iv) has served in the district (any capacity) for a minimum of one year.

(v) proposed because our Club has no candidate proposed for District Governor Nominee of RI Dist. 3170 for the year 2015-16.

Name of the President: _________________________________ Signature:____________________

Name of the Secretary: _________________________________ Signature:____________________

 

 We, Rtn. ____________________________________ Regular candidate for the DGNC and
Rtn. ___________________________________Alternate candidate for the DGNC here by consent to our appointment by our Club and state that :-

1. We have read, understood and will unconditionally abide by the DGN Election Pilot document.

2. We are not immediate relative (spouse, father, mother, son, daughter, son-in-law, daughter-in-law,
father-in-law, mother-in-law, brother or sister) or close business associate (partner or director in the same firm) of any candidate for District Governor Nominee

Name of Regular DGNCM candidate: _____________________________

                                                                                                                                                                       Stick

                                                                                                                                                                   PHOTO of
                                                                                                                                                    Candidate

                                                                                                                                 Sign:

 

 

Name of Alternate DGNCM Candidate: ______________________________

                                                                                                                                                          Stick
                                                                                                                                                       Photo of
                                                                                                                                                     Candidate

                                                                                                                                 Sign:

Note: Please sign across your photograph for self certification.

 

Please type the same on the Club Letter Head:-

 

RESOLUTION:-

“The members of Rotary Club of _____________________________________ from R.I. District 3170 at the regular weekly meeting of the Club held on ___________________(date) have read and understood the Governor Nominee Election Pilot and in accordance have unanimously resolved to propose the names of :-

1. Rtn. __________________________________________(Regular Candidate  to the RI Dist. 3170 Dist. Governor Nomination Committee for the year 2012-13)

And

2. Rtn. __________________________________________ (Alternate Candidate to the RI Dist. 3170 Dist. Governor Nomination Committee for the year 2012-13)”

WE, the President and Secretary certify that the above resolution is the true extract from the Minutes of the Regular weekly meeting referred above of Rotary Club of ____________________.

Name of President: __________________________________________ Signature:_________________

Name of Secretary:___________________________________________Signature:_________________

 

 

Please Note that the date of the resolution must be after 15^th. Sept. 2012.