滞納金を理由とする活動停止処分を受けた解散からの復帰 Facebook

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CLUB REACTIVATION REPORT From Financial Suspension Please forward to Accounts Receivable and Club Account Services Club Name Club Number District The following have been completed: Club has paid its account balance (attach copy of receipt).REACTIVATION AND NEW MEMBER FEES New/Former Members @US$35.00 per member Total amount enclosed OFFICERS OF THE CLUB (List Full Names) PRESIDENT Name: First/Given Name Member Number: Middle Initial Last/Family Name Male Female Home Address: City State/ Province/ Country Postal /Zip Code Billing Address: City State/ Province/ Country Postal /Zip Code Telephone (Mobile):Telephone (Res):Fax: E-mail: SECRETARY Name: First/Given Name Member Number: Middle Initial Last/Family Name Male Female Home Address: City State/ Province/ Country Postal /Zip Code Billing Address: City State/ Province/ Country Postal /Zip Code Telephone (Mobile):Telephone (Res):Fax: E-mail: TREASURER Name: First/Given Name Member Number: Middle Initial Last/Family Name Male Female Home Address: City State/ Province/ Country Postal /Zip Code Billing Address: City State/ Province/ Country Postal /Zip Code Telephone (Mobile):Telephone (Res):Fax: E-mail: District Governor’s Signature Date 1st Vice District Governor’s Signature Date District Governor's approval is required to reactivate up to 10 clubs during this term. After 10 clubs have been reactivated, approval to reactivate additional clubs will be required from both the District Governor and First-Vice District Governor. CLUB REACTIVATION REPORT (REINSTATED MEMBERS) Please list reinstated club members who were in the club when it was placed on Financial Suspension and who are continuing their membership in the club. Provide full name (not nickname),member number and address. Club Name Name Member Number Name Member Number Name Member Number Name Member Number Name Member Number Name Member Number Name Member Number Name Member Number Name Member Number Name Member Number District Date Address Family Unit Postal code No Yes Address Family Unit Postal code No Yes Address Family Unit Postal code Yes No Yes No Yes No Yes Head of Household Name (if applicable) Postal code No Yes Address Family Unit Head of Household Name (if applicable) Postal code Address Family Unit Head of Household Name (if applicable) Postal code No Yes Address Family Unit Head of Household Name (if applicable) Postal code Address Family Unit Head of Household Name (if applicable) Postal code No Yes Address Family Unit Head of Household Name (if applicable) Postal code Address Family Unit Head of Household Name (if applicable) No Address Family Unit Head of Household Name (if applicable) Head of Household Name (if applicable) Postal code No Yes Head of Household Name (if applicable) CLUB REACTIVATION REPORT (REINSTATED MEMBERS) Please list reinstated club members who were in the club when it was placed on Financial Suspension and who are continuing their membership in the club. Provide full name (not nickname),member number and address. Club Name Name Member Number Name Member Number Name Member Number Name Member Number Name Member Number Name Member Number Name Member Number Name Member Number Name Member Number Name Member Number District Date Address Family Unit Postal code No Yes Address Family Unit Postal code No Yes Address Family Unit Postal code Yes No Yes No Yes No Yes Head of Household Name (if applicable) Postal code No Yes Address Family Unit Head of Household Name (if applicable) Postal code Address Family Unit Head of Household Name (if applicable) Postal code No Yes Address Family Unit Head of Household Name (if applicable) Postal code Address Family Unit Head of Household Name (if applicable) Postal code No Yes Address Family Unit Head of Household Name (if applicable) Postal code Address Family Unit Head of Household Name (if applicable) No Address Family Unit Head of Household Name (if applicable) Head of Household Name (if applicable) Postal code No Yes Head of Household Name (if applicable) CLUB REACTIVATION REPORT (NEW or TRANSFER MEMBERS) Please list new or transfer club members. Provide full name (not nickname) and address. For transferring members include former club name and member number. Club Name District Name Member Number Address Former Club Name Name Member Number Former Club Name Former Club Name Former Club Name Former Club Name Former Club Name Former Club Name Former Club Name DA-970-FS Rev 6/17 Head of Household Name( if applicable) Family Unit Postal code No Yes Head of Household Name (if applicable) Family Unit Postal code No Yes Head of Household Name (if applicable) Family Unit Postal code No Yes Head of Household Name (if applicable) Family Unit Postal code No Yes Head of Household Name (if applicable) Address Former Club Name Name Member Number Family Unit Postal code No Yes Address Name Member Number Head of Household Name (if applicable) Address Name Member Number Family Unit Postal code No Yes Address Name Member Number Head of Household Name (if applicable) Address Name Member Number Family Unit Postal code No Yes Address Name Member Number Head of Household Name (if applicable) Address Name Member Number Family Unit Postal code No Yes Address Name Member Number Date Family Unit Postal code No Yes Head of Household Name (if applicable) Address Former Club Name Family Unit Postal code No Yes Head of Household Name (if applicable)
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