Certificate of Election of Delegates & Alternates

This form must be submitted by the Circle K Club President or Secretary.

Each chartered club in good standing (one that has paid BOTH District and International Dues) shall be entitled to two (2) delegates at DCON. These delegates should be elected prior to DCON. Each delegate shall be entitled to cast one vote. In his/her absence, the duly certified alternate may cast one vote. There shall be no voting by proxy.

Certificate of Election of Delegates and Alternates


Delegate 1 Name:(Required)
Delegate 1 Address:(Required)
Delegate 2 Name:(Required)
Delegate 2 Address:(Required)


Alternate 1 Name:(Required)
Alternate 1 Office:(Required)
Alternate 1 Address:(Required)
Alternate 2 Name:(Required)
Alternate 2 Office:(Required)


Name of Club Officer Completing Form:(Required)
Office held (only Club President or Secretary allowed to submit form)(Required)
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