Perry Fellow Mail In

Stan Perry Life Fellow Award Mail In

Name Of Individual Donor or Kiwanis Club(Required)

First Last Club

If the donation is made by an individual then give first and last name. If donation is being made by a Kiwanis Club, put your club’s name in the “Club” box.

Address(Required)

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

Phone(Required)

Email(Required)

Honoree Name(Required)

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

Donation Amount(Required)

$600 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.

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

Perry Fellow Mail In

Stan Perry Life Fellow Award Mail In