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DELEGATE CERTIFICATION FORM
2015-2016 FLORIDA DISTRICT OF KEY CLUB INTERNATIONAL
Each Key Club can select two delegates and two alternates to represent their club at
the House of Delegates at the 2015 Key Club District Education and Leadership Conference.
Delegates will elect the 2015-2016 leaders of the Florida District of Key Club and vote on any
proposed amendments to the Bylaws.
This Delegate Certification Form must be completed and delivered in one of the three
ways. By mail to the Florida Key Club District Office by March 19, 2015, emailed to the election
Chair by March 30th, or presented to the Credentials Desk at the District Conference. This certifies
that the persons named below have been selected as delegates by the club. At the
conference, there will be a credentials registration table in the conference registration area.
Each delegate will be issued a delegate ribbon which allows entry into the House of Delegates.
For questions or information, please contact Elections & Credentials Chair Krysten Pazik at
elections@floridakeyclub.org
Please print:
THIS DOCUMENT SHALL SERVE AS CERTIFICATION that the following members of the
KEY CLUB of ______________________________________________________________ ____ (school)
of Division _________ are the duly elected delegates and alternates of this club to the 77th
Annual Florida Key Club District Education and Leadership Conference.
Delegates
1. ____________________________________________
2. ____________________________________________
Alternates
1. ___________________________________________
2. ___________________________________________
One of the following must sign this form:
2014-2015 Club President (sign) ______________________________________ Date _________________
2014-2015 Club Secretary (sign) ______________________________________ Date _________________
Faculty Advisor (sign) ________________________________________________ Date _________________
Note: Each chartered club in good standing is entitled to two delegates to the House of
Delegates. Alternates should be chosen for each delegate. Each delegate shall be entitled to
cast one vote. The alternate may cast the vote if the elected delegate cannot attend the House
of Delegates. There shall be no voting by proxy. No club delinquent in the payment of dues shall
be considered in good standing.