Charter Presentation Supplies Order Form
To allow time for shipment, we need this form at least two weeks prior to the charter ceremonies for clubs chartering in the Untied States, three weeks prior for clubs chartering in Canada, and one month prior for all other clubs chartering outside of North America.
New Club Name: District Dist. No.
Sponsoring Club: Sponsoring Club Number:
Club Builders:
Ship To: Name
Address
(Must have street address since shipment is by UPS delivery)
City/State/Province/Postal Code
Civitan International gifts for the club — Banner (order form also on CD)
Quantity Per Club: (1) M701 Charter (1) T533 Accounting Book (1) T536 Receipt Book
(2) K656 Reference Books (1) S524 18" Road Sign - Logo only
Civitan International gifts for each charter member:
K66C New Member Kit (includes A102 Charter Member Pins B47 Perma-Name Badge
creed, Membership ID Cards welcome letter, current issue CF242 Charter Member Certificate
of the Civitan Magazine, and 8 1/2 x 11" frame) (Certificate sent separately to club builder for signature)
Please indicate the exact number of lapel pins needed above. Note: Civitan International provides a lapel pin for each member of a new club, officers will receive both a member and officer lapel pin. Indicate pins needed by circling or fill in the blanks.
B118 Director Pins (limit 3) 1 — B105 President Pin 1 — B106 President-Elect Pin
1 — B109 Secretary Pin 1 — B111 Treasurer Pin
Extra Member Sets (see below) 1 — B114 Chaplain Pin 1 — B116 Sergeant-at-arms Pin
Extra Member Sets -- If you anticipate chartering with more members than reported on this form, you may choose to order up to five extra member sets. If the additional charter members are not reported within two weeks after the charter presentation date, Civitan International will bill the sponsoring club for those extra supplies ordered. Should you charter with membership beyond the supplies ordered, extra sets will be sent automatically by Civitan International upon receipt of the names and fees for the additional charter members.
Civitan International Membership-Leadership Gift Items — When chartering with 25 or more members, the new club may choose from the following items as “free gifts” from Civitan International:
A club chartering with:
25 to 39 members is eligible for 1 free item 40-49 members is eligible for 2 free items
50 to 59 members is eligible for 3 free items 60 or more members is eligible for 4 free items
C2 Luncheon Bell with C861 Gavel W548 Table-top speaker’s lectern
T531 Scrapbook C27H Portable Banner Stand
F48 "Civitan Club Meets Here" plaque for display at meeting place
It is the responsibility of the club builder to notify the Membership-Leadership Department of the club’s choice/choices of the free items as applicable. You may indicate choice of free items below:
Choice 1 Choice 2 Choice 3