ROTARY CLUB NAME:   

ROTARY YEAR:

INCOMING PRESIDENT'S NAME:   

INCOMING PRESIDENT SPOUSE'S NAME:   

INCOMING PRESIDENT'S ADDRESS INCLUDING ZIP CODE: 

INCOMING PRESIDENT'S HOME PHONE NUMBER INCLUDING AREA CODE:   

INCOMING PRESIDENT'S OFFICE PHONE NUMBER INCLUDING AREA CODE:   

INCOMING PRESIDENT'S FAX NUMBER INCLUDING AREA CODE:   

INCOMING PRESIDENT'S e-MAIL ADDRESS:   

INCOMING SECRETARY'S NAME:   

INCOMING SECRETARY SPOUSE'S NAME:   

INCOMING SECRETARY'S ADDRESS INCLUDING ZIP CODE: 

INCOMING SECRETARY'S HOME PHONE NUMBER INCLUDING AREA CODE:   

INCOMING SECRETARY'S OFFICE PHONE NUMBER INCLUDING AREA CODE:   

INCOMING SECRETARY'S FAX NUMBER INCLUDING AREA CODE:      

INCOMING SECRETARY'S e-MAIL ADDRESS:   

YOUR NAME:   

YOUR e-MAIL ADDRESS:   

Please submit report before February 15th each year

Note:  You may mail or fax a copy of this form (need to print a copy now) to the Webmaster.  If you wish to send this form by e-mail please click on the submit button below.  It will be automatically send to the District Governor Elect, District Administrative Assistant Elect and Webmaster.

Webmaster:  Steve A. Dennis, GSWW, Inc., 1030 Andrews Hwy., Suite 211, Midland, Texas 79701, Ph. 432-689-8909 (O), 432-367-4953 (H), 432-689-8911 (Fax)

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