Toastmasters District 22 in Kansas and Western Missouri

NOTE that this form is due four weeks before the district conference

Are you interested in nominating yourself or someone else for district leadership position? If so, please complete the form below and submit it to the District Nominations Committee Chair. If you are nominating someone else, you may submit more than one person's name for each position.

To be nominated or elected, a person must be a member in good standing, meet the qualifications of the office, must consent to being nominated, and, must sign an Officer Agreement and Release Form.

Complete the form below then click the "Submit" button. That will send your form as an email to the District Nominations Chair.


Member Last Name:
Member First Name:
Address:
City/State/Zip:
Contact Phone(s):
Contact email:
Home Club Name and Number:	Club list
District Office for which you want to nominate the member:
List the Club and District offices in which this person has served and the dates of service. Describe this Toastmaster's qualifications for office and fitness to serve. Please include any other information about this candidate that may be helpful to the Nominations Committee.
Your Name:
Today's Date: