KIWANIS INTERNATIONAL
MEMBER SUPPORT CENTER-EUROPE, Leiekaai 25 D, B-9000 GENT, BELGIUM
Phone: +32 (09) 216 77 77	Fax: +32 (09) 216 77 70	E-mail: info@kiwanis.eu

APPLICATION FOR CHARTER PRESENTATION       DEMANDE DE PRESENTATION DE LA CHARTE 
ANTRAG FÜR CHARTER-ÜBERGABE                        DOMANDA DI PRESENTAZIONE DELLA CHARTER

Kiwanis Club of_____________________________District____________________ K No. _______

Language spoken in Club	 Lingua parlata nel club
Umgangsprache im Club_________________________ Langue parlée dans le Club_________________________ 

Sponsored by :
Club(s) parrain(s) _____________________________________________________________________________
Patenclub(s)
Club(s) Sponsor _______________________________________________________________________________

Date chosen for charter presentation 
Date prévue pour la remise de Charter
Gewähltes Datum für Charterübergabe                  ____________________________________________________
Data prevista per la consegna della Charter

The Charter presentation shall take place at
La présentation de la Charter aura lieu à       ________________________________________________________
Die Charterübergabe findet statt in
La presentazione della Charter avrà luogo a _________________________________________________________

Active membership today	
Nombre actuel de membres actifs
Anzahl Aktivmitglieder heute    __________________________________________________________________
Numero attuale dei membri attivi

With my signature I confirm that the above Club has at least  20 members.
Je confirme par ma signature que le Club précité a au moins 20 membres.
Mit meiner Unterschrift bestätige ich, dass der oben genannte Club mindestens 20 Mitglieder hat.
Con questa firma confermo che il sumenzionato club ha minimo 20 membri.

Date/Datum			             Firma
Date/Data _______________________      Signature/Unterschrift_______________________________________
								                  (Club President)

Date/Datum 				Firma	
Date/Data _______________________       Signature/Unterschrift_______________________________________
							                               (Club Secretary)

Date/Datum			             Firma
Date/Data _______________________      Signature/Unterschrift_______________________________________
								                  (District Governor)

Please return completed with all signatures at least 3 weeks before Charter Presentation to:  
Retourner complété et muni de toutes les signatures au minimum 3 semaines avant la remise de Charter à: 
Bitte vollständig mit allen Unterschriften mindestens 3 Wochen vor Charter-Übergabe senden an:
Ritornare per favore con tutte le firme al completo minimo 3 settimane  prima della Charter a:
KIWANIS INTERNATIONAL MEMBER SUPPORT CENTER-EUROPE
Leiekaai 25 D
B-9000 Gent
Belgium