District Convention Delegate Certification

Online Submission closes July 23, 2025

You may also mail your Delegate Certification using this form. Form must be received at the District Office no later than July 20, 2025.

Click here for House of Delegate Information

This form should ONLY be filled out by your Club President or Secretary.

Kiwanis Club of(Required)

Key Number

Read-only

Division

Read-only

Would you like to register

Up to 3 members of your club as delegates

Past Lt Governor that is not a member of your club

Delegates

You can register up to 3 Club Members. Please click “Add Delegate” to add delegates.

Delegates

Row ID	Name	Actions

There are no Delegates.

Alternate Delegates

You can pre-certify up to 2 Club Members as alternate delegates in event one of the above delegates does not attend District Convention. Please click “Add Alternate Delegate” to add alternates.

Alternate Delegates

Row ID	Name	Actions

There are no Alternate Delegates.

Other Representative

You can register 1 Past Lt Governor from your Division that is not a member of your club. Please click “Add Past LtG” to add your representative.

Other Representative

Row ID	Name	Actions

There are no Past LtGs.

Past LtG Kiwanis Club(Required)

Year as Lt Governor(Required)

Certification

Club President Name(Required)

First Last

Club President Email(Required)

Club Secretary Name(Required)

First Last

Club Secretary Email(Required)

Kids Need Kiwanis

District Convention Delegate Certification

Delegates

Alternate Delegates

Other Representative

Certification