IOWA LIONS
G. E. "BUD" KLISE LEADERSHIP AWARD
9___ LEADER OF THE YEAR

NOMINEE:

Name: ______________________________________

Address: ___________________________________
_______________________________________________

Phone: ______________________

Club Name: ________________________________

NOMINATED BY:

Name: ______________________________________

Address: ___________________________________
_______________________________________________

Phone: ______________________

SERVICE RECORD OF NOMINEE:

Years a Member: ___________

OFFICE(S) HELD AT CLUB, DISTRICT AND MULTIPLE DISTRICT:
 
 
 
 
 
 
 

NUMBER OF NEW MEMBERS _______ EXTENSION AWARDS _______

NAMES OF CLUBS __________________________________________

AWARDS RECEIVED FOR SERVICE:
 
 
 
 
 
 
 

LEADERSHIP ACTIVITY: Tell why you feel the nominee should be awarded the Klise Leadership Award. This award is in recognition of demonstrated leadership ability at any level; Club, District and Multiple District. Use as many attached sheets as necessary. Must be typewritten.

RETURN NOMINATION TO: