Kiwanians Who Passed in the Last Year

Before completing this form have a picture (no more that four) of your friend in your computer and ready to upload. Please write a short paragraph honoring your Kiwanian.
The paragraph and pictures will be read and shown at the DCON ceremony.

CLUB INFORMATION (Club Name, Key Number, Division) *

CLUB INFORMATION (Club Name, Key Number, Division)

YOUR NAME (First & Last) *

YOUR TITLE *

YOUR EMAIL ADDRESS *

Enter Email

Confirm YOUR EMAIL ADDRESS *

Confirm Email

Report

Kiwanian Who Passed FIRST NAME, LAST NAME *

Date of Passing *

Paragraph to be read at the ceremony. *

Drop 1-4 pictureS of your friend into this box. (only .jpeg's can be used)

Maximum upload size: 516MB

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