Inner Wheel Australia Form 30

INNER WHEEL AUSTRALIA FORM 30

ORDER FORM FOR CLUB BADGES 2011-2012

(See IWA Website to identify different badges/brooches)

To be returned to
District Badge Officer by 25 February 2011 / Date of Order
CLUB / DISTRICT A80
IW2 Club Member’s Badge / No. Required
PRESENT OFFICERS Die Bars
Dark Blue Enamel / PAST OFFICERS Die Bars
Dark Blue Enamel
No. Required / No. Required
President / Past President
Vice President
Secretary / Past Secretary
Treasurer / Past Treasurer
Committee / Past Committee
International Service / Past International Service
Club Correspondent / Past Club Correspondent
Historian / Past Historian
Editor / Past Editor
Social Convenor / Past Social Convenor
Extension / Past Extension
ENGRAVED BARS / IW9 Past
President’s Brooch
Honoured Active
Honorary / Collar ribbon (dark blue)
Club Name Bars / (Please Print) Club Name / No. Required
MEMBERS NAME BARS (Please Print) Attach typed list if necessary
Name
Name
Name
COLLAR BARS (Please Print) Attach typed list if necessary
Name / Year
Name / Year
Delivery to / Name
Address
Post Code
Phone / Fax
Email
Date Order Received / Order No
Date Order Dispatched / Invoice No

Form 30 Club Badges Orders Revised February 2010