Hyatt Application

Carl B. Hyatt Award

Name(Required)

First Last Club

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Enter Email Confirm Email

Honoree Name(Required)

Please put the Honoree’s name exactly as it should appear on the desk trophy with the correct spelling.

Donation Amount(Required)

$1000 USD

$1025 +S&H

This award can be presented to the honoree either at the Mid-Year or Annual District Convention ($1,000 Total). If the award is to be presented at a local club meeting or event then a $25 shipping and handling fee is required ($1025 Total).

Total

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Hyatt Application

Carl B. Hyatt Award