LETTER
OF INTENT
California
South District 41
Jim Walker, Governor
2010-2011
CANDIDATE
FOR THE OFFICE OF:
Governor Elect 2011-2012
Lieutenant
Governor
2011-2012
Zone _____
Name:
_____________________________________ Address:
______________________________________________________
Tel: Res ____________________________ Cell ________________________________
e-Mail ____________________________
Spouses
name: ______________________________ Children’s [optional]
_____________________________________________
Home Optimist Club _____________________________________________________
Optimist Club number ____________
Date
you became an Optimist _____________________ your member number
41-________________Dual Member? [Y/N]
___
I have held the
following Optimist Club and District positions:
PRESIDENT:
Optimist Club ____________________________________________________ Year
_____________
Other
positions/committees
___________________________________________________________________________________
LIEUTENANT GOVERNOR: Year
_________
District _______
Zone __________________
OTHER______________________________________________________________________________________
Positions held with other
Optimist Clubs.
______________________________________________________________________________________
Signed: _________________________________________________
Dated_____________________________ 2011
Current Optimist Club President
I hereby certify by my signature that the ____________________________________ Optimist Club supports the above named member of our Optimist Club, for the California South District 41 office indicated above.
Signed: ________________________________________,
President Dated:
_____________________ 2011
Return this completed form on
or before September 1st, 2011 to Chairman of the Candidate
Qualifications Committee, Immediate Past Governor, Dr. Lucille LeMieux
328 Camino del Cerro Grande, Bonita, CA 91902-2412. Questions 619-267-4057.