District Officer Nominating Form and Officer Agreement Release Form

DISTRICT OFFICER NOMINATING FORM
DISTRICT 51 P & R (2009 - 2010)

District officer elections will take place on Friday, May 21 st 2010. Names to be considered for
nominations are being accepted for the following offices: DISTRICT GOVERNOR; LT. GOVERNOR
EDUCATION AND TRAINING; LT. GOVERNOR MARKETING; and DIVISION GOVERNOR for the term JULY
2010 through JUNE 2011. If you would like to be nominated for office or if you want to enter a person’s
name for nomination, please complete the form below and email or mail to the District Nominating
Committee Chairman. You may submit more than one person’s name (including your own) for each
position. The deadline for submitting this form is Friday, April 16 th 2010 5pm GMT +8 Malaysian
time. The Nominating Committee will consider all candidates received by this deadline. To be nominated
or elected, a person must be a member in good standing, meet the qualifications of the office, must
consent to being nominated, and must sign an Officer Agreement and Release Statement.
Note: Area Governors shall be elected at the respective Area Council and the names must be
submitted to the respective Division Governors & District Governor not later than 07 th May 2010.
The current serving Area Governors shall call nomination for Area Governors.
This nomination form shall be used for nomination of District 51 officers for the term 2010-2011
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2010 - 2011 District Officer Nominating Form
I wish to have the Nominating Committee consider the following person for the office of:
District Governor ( D51P / D51R )
Lieutenant Governor Education & Training (D 51P / D51R)
Lieutenant Governor Marketing ( D51P / D51R )
Division Governor, (please specify Division) (D51P / D51R)
Name CC AC DTM
Address
State/Prov. City Postal Code
Country Email
Telephone (M) (B) FAX
Home Club Name Club No.
List the Club and District offices in which this person has served and the dates of service. Describe this
Toastmaster’s qualifications for office and fitness to serve. Please attach any other information about this
candidate that may be helpful in assisting the Nominating Committee.
_________________________________________________________________________________________________________________________
Submitted by: (Name & Club Number)
Date:
Please e-mail or mail to:
Ho Fong Ming, DTM
Chairman, District Nominating Committee (2010-2011) Mailing Address:
Email : [email protected] B1-23 Sri Cassia apartment
Mobile Tel : +6 016 – 216 1989 Laman Puteri 1, Bandar Puteri
Work Tel : +6 03 – 8060 9509 47100 Puchong, Selangor, Malaysia.
OFFICER AGREEMENT AND RELEASE FORM

Directions:

Toastmasters International requires that any candidates running for and/or holding office, whether
elected or appointed, agree to and sign the Officer Agreement and Release Statement below. Please
submit your signed form to the Chairman of the Nominating Committee.

Officer Agreement and Release Statement:

Consistent with my desire to take personal responsibility for my conduct, individually and as an Officer of
Toastmasters International and as a member of a Toastmasters Club, I agree to abide by the principles
contained in "A Toastmaster's Promise" and the governing documents and policies of Toastmasters
International and my Club. I will fully comply with my fiduciary duties to Toastmasters International
under its governing documents and the law of the land. I will refrain from any form of discrimination,
harassment, derogatory, illegal, or unethical conduct, and I understand that if I engage in such conduct, I
may be responsible to reimburse Toastmasters International, my Club or other Clubs, or other
individuals involved with Toastmasters, for any damages, losses, or costs resulting from my conduct.
Understanding that Toastmasters programs are conducted by volunteers who cannot be effectively
screened or supervised by Toastmasters International or its Clubs, I release and discharge Toastmasters
International, its Clubs, governing bodies, and representatives from any liability for the intentional or
negligent acts or omissions of any member or Officer of my Club or other Clubs, or any Officer of
Toastmasters International.

Confirmation

I have read and agree to the terms and conditions of the Officer Agreement and Release Statement

Signed : _______________________________________________________
Name (please print): ________________________________________________________
Club Name & Number: ______________________________________________________

District Office : _______________________________________________________
(Indicate D51P or D51R although D51R will be officially known as D87 beginning July 01 st 2010)
Date : __________________________

Please e-mail or mail to:

Ho Fong Ming, DTM
Chairman, District Nominating Committee (2010-2011) Mailing Address:
Email : [email protected] B1-23 Sri Cassia apartment
Mobile Tel : +6 016 – 216 1989 Laman Puteri 1, Bandar Puteri
Work Tel : +6 03 – 8060 9509 47100 Puchong, Selangor, Malaysia.

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DISTRICT OFFICER NOMINATING FORM

DISTRICT 51 P & R (2009 - 2010)

Submitted by: (Name & Club Number)

Name (please print): ________________________________________________________

Club Name & Number: ______________________________________________________

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