Name: *

First Name

Last Name

Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone:

(###)

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Cell Phone: *

(###)

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Business Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Work Phone:

(###)

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Date: *

Today's Date

MM

DD

YYYY

Greater satisfaction and benefit come from participation in Club activities through committee membership. *

Check all that apply:

Community Service: Determines, plans and supervises community serving projects.

Fellowship: Stimulates attendance, greets members and guests. Promotes fellowship beyond Club and community.

Finance: Plans and supervises the budget.

Membership: Plans and executes a year-round program for acquiring new members.

New Club Building: Conducts all activities involved in sponsoring a new Optimist Club.

Programs: Develops and executes plans to provide interesting programs for Club meetings.

Youth Activities: Determines, plans and supervises youth projects.