OFFICIAL VISIT SCHEDULING REQUEST FORM

For DG Robert Holliday, District 9x9

Club Name _________________________________________________

Contact Person ______________________________________________

Phone Number _______________________ Email _________________________

Meeting Place _______________________________________________________

Address ____________________________________________________________

City ____________________________

Meeting Time _________________ A.M. or P.M.

Visit Date __________________________________ (1^st Choice)

__________________________________ (2^nd Choice)

Are there any special topics that I should address? ________________________________________________________________________________________________________________________________________________

Our club would like you to:

_____ Install new officers

_____ Induct new members

_____ Present awards (please specify what awards will be presented) *

_____ Other:_________________________________________________

* __________________________________________________________

Please complete and return this form as soon as possible to:

DG Robert Holliday

2325 Elm Street

Davenport, IA 52803-2302

Or send the same information by email to: YncCpo@aol.com

Please complete this form even if you have confirmed an official visitation date over the phone or in person.

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