Hyatt Fellowship Mail In

Carl B. Hyatt Award Mail In

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

$25 S&H

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

Total

Payment By Check

Copy this form and make your check payable to Carolinas District Kiwanis Foundation. Mail to: Jason Poole, CDKF Treasurer PO Box 53702 Fayetteville, NC 28305

Kids Need Kiwanis

Hyatt Fellowship Mail In

Carl B. Hyatt Award Mail In