Consent and Assurance

LIEUTENANT GOVERNOR’S DUTIES AND RESPONSIBILITIES
Prior to election to the office of Lieutenant Governor of the Division of the Pacific Northwest District of Kiwanis International indicated in the form below, I have been informed of the Duties and Responsibilities of that office and I understand them to be as follows:

• As Lieutenant Governor-designate, I will attend the District Convention held during the current year, Lt. Governor Training, and will also attend the Club Leadership Education Training in my area, Training Sessions, and Board Meetings held before and after the convention.
  
• As Lieutenant Governor-designate, I will arrange and conduct a Training Conference for Club Officers following the District Club Leadership Education (CLE) Training and prior to October 1.
  
• As the Lieutenant Governor-designate, I will make a minimum of one EDUCATION & CONTACT VISIT to each club in the Division. The EDUCATION & CONTACT VISIT will be made prior to October 1.
  
• In addition to the EDUCATION & CONTACT VISIT, I will make and report one OFFICIAL CLUB VISIT and one OFFICIAL BOARD VISIT to each club in the Division during my tenure. This will constitute a minimum of three visitations to each and every club in the Division, either personally or electronically, as part of the Lieutenant Governor’s duties.
  
• I will file Lieutenant Governor reports by the following dates: December 1, March 15, May 1, July 31
  
• As the Lieutenant Governor, I will attend Club Leadership Education (CLE) Training in my area and scheduled District Board Meetings for Mid-Winter and at District Convention and other interim Board meetings announced by the district.
  
• Attendance at the International Convention is a highlight of the Lieutenant Governor’s year in office. I will attend if it is at all possible
  
• As Lieutenant Governor, I shall promote the International, District, and Divisional Programs of Services; and District and Division Goals as set forth by, and under the direction of, the District Governor.
  
• As Lieutenant Governor, I will issue a monthly bulletin to the clubs of the Division, the Governor, and the District Secretary.
  
• As Lieutenant Governor, I will secure a successor in the manner provided in ARTICLE VII, Section 5 of the District Bylaws. In no event shall the election of a successor be delayed beyond the limits specified in the Bylaws. At the same time, I will secure a qualified individual to serve as Lieutenant Governor-elect for the succeeding year.

LTG Consent and Assurance Form

Δ

Contact Information

Update Database(Required)

Do you want us to update your contact information in KI’s database?

Yes

No

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

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

Division Name(Required)

Indicate the Division you will represent as Lt. Governor.

Select a Division name.Alaska – Last FrontierCascade-SiskiyouCentral OregonFour Rivers AreaFrom Coast to CanalGreater PalouseGreater PortlandGreater SpokaneGreater Vancouver IslandGreen River AreaLake Washington – E.Lower ColumbiaMid-Columbia RiverMid-Puget SoundMount Baker ViewsMt. Hood AreaMt. Rainier AreaNorth CascadesNorth Puget SoundNortheast OregonNorthern IdahoNorthwest OregonOlympic ViewSW WashingtonThe Apple CapitalThe BC InteriorThe Fraser ValleyWest Pierce CountyWillamette ValleyYakima River Basin

Club Name(Required)

Please select your club name.25+ Kiwanians Who Care – PNW – K20362Abbotsford – K06461Airway Heights – K18063Albany – K01125Anacortes – K01508Anacortes, Sunrisers – K09438Anchorage – K05985Arlington – K04260Ashland – K03023Astoria – K00140Auburn – K00795Bainbridge Island – K04995Baker City – K00587Ballard, Seattle – K01701Battle Ground – K03246Bay Area (The) – K01908Bellevue – K03565Bellingham – K00666Bend – K21354Bonney Lake – K15012Bremerton – K00617Buckley – K01726Burlington-Edison – K03229Burns-Hines – K01890Canby – K02237Cascade Park – K12886Cascadia – K17784Caveman, Grants Pass – K07555Cedar Hills, Beaverton – K06246Central Okanagan – K12469Centralia-Chehalis – K00723Chena-Fairbanks – K06274Cheney – K07069Chewelah – K02569Chilliwack – K05376Clatskanie – K01776Cle Elum – K00868Clearbrook – K08655Clover Park – K05595Coast Fork (The) – K13787Coeur D'Alene – K00801Colfax – K20941Columbia Gorge (The) – K18054Colville – K01917Corvallis – K02730Corvallis Sunrisers – K11381Courtenay – K03380Covington – K13840Daffodil Valley, Puyallup – K05492Dayton – K00882Deer Park – K16453Downtown Spokane – K00287Duncan – K03344East Spokane – K02674Eastmont, East Wenatchee – K10093Edgewood-Fife-Milton – K05901Edmonds – K09019Ellensburg – K00805Ellensburg-Rodeo City – K05582Emerald Empire (The), Eugene – K04239Ephrata – K02802Esquimalt 321 – K19020Eugene – K00223Fairbanks – K02786Federal Way – K04468Fern Ridge, Veneta – K13030Ferndale – K06895Fircrest – K04451Florence – K09633Fort Vancouver, Vancouver – K00883French Prairie Woodburn – K09794Friday Harbor – K11862Gig Harbor – K06446Gladstone-Oak Grove – K04232Golden Ears, Maple Ridge – K11739Goldendale – K10689Grants Pass – K03074Greater Kingston – K11286Greater Poulsbo – K08252Greater Seattle – K21169Greater Woodland-Kalama – K20166Hermiston – K03779Highline, Burien – K02261Hillsboro – K04099Hood Canal, Hoodsport – K09204Horse Heaven Hills (The) – K17514Idaho Panhandle, Coeur D'Alene – K06613Issaquah – K01873Issaquah Valley – K10033Kamiah – K10536Kamiakin, Yakima – K05186Kelso Longview – K01489Kennewick – K01625Kent – K01930Kent-AM – K17195Kirkland – K03048Klamath Falls – K00900Kodiak – K10946Kristmas Town, Shelton – K07171Laconner – K09195Lake Oswego – K20338Lake Stevens – K06966LC Valley – K20202Liberty Lake – K16232Lincoln City – K02947Linkville, Klamath Falls – K05317Lynden – K05737Lynden-Breakfast – K07537Lynnwood – K05741Madras – K02957Mc Minnville – K01188Medical Lake – K09176Mercer Island – K05312Mill Creek – K19352Milton-Freewater – K10119Monroe – K01798Montavilla, Portland – K01895Montesano – K07145Moscow – K01553Moses Lake – K02817Mount Vernon – K01193Mukilteo – K15338Newberg – K03009North Central, Seattle – K01915North Mason, Belfair – K05559North Spokane – K02676Northeast Spokane – K02678Northshore, Bothell – K05953Oak Bay, Victoria – K02882Oak Harbor – K06362Okanogan – K02093Oliver – K05656Olympia – K00563Omak – K01964Orcas Island – K13056Osoyoos – K17192Palmer – K03369Parkland-Spanaway – K09831Pasco – K01395Pendleton – K01529Penticton – K02638Pioneer Community of Mason County, Shelton – K12224Port Angeles – K00554Port Angeles-Olympic – K07779Port Orchard – K01850Port Townsend – K03282Post Falls – K02943Powell River – K05292Prince George – K04251Prineville – K03064Providence Point, Issaquah – K11644Pullman – K00727Puyallup – K00590Redmond OR – K02185Redmond WA – K17416Renton – K01875Republic – K02293Richland – K02587Richmond – K02590Ridgefield-La Center – K21213Rogue River – K09676Roseburg – K01114Ross Island Earlyrisers, Portland – K09832Saddle Mountain – K18371Saint Helens – K01602Saint Maries – K02476Salem – K00579Salmon Creek, Vancouver – K16018Sandpoint – K01615Sandy – K02980Sardis – K09483Scappoose – K02910Seaside – K01767Seattle – KCCP-S – K19892Shelton – K01241Sidney and Saanich Peninsula – K18807Silver Valley, Kellogg – K01663Silverdale – K11799Silverton – K05827Siskiyous (The) – K03831Sisters – K08985Slabtown Area – K19449Snohomish – K04319Snoqualmie Valley – K01913South Bend – K01288South Kitsap Breakfast – K15289South Seattle – K04035Southwest Spokane – K14956Spokane Valley, Spokane – K07752Springfield – K03234St. Helens Day Breakers – K12425Stanwood-Camano – K06334Stayton – K05439Steilacoom – K14249Summerland – K03297Table Rock – K13188Tacoma – K00120Takena, Albany – K05217The Dalles – K00642Tigard – K05921Tillamook – K00913Tonasket – K03270Trail – K02643Tri-Cities Industry – K10392Tualatin – K10019University, Seattle – K01648Vancouver – K00126Vernon-Four Seasons – K13255Victoria – K00198Wacoka of Cashmere – K13141Walla Walla – K00757Wenatchee – K01371Wenatchee-Apple Valley – K06138West Seattle – K01857West Valley, Spokane – K02873West Valley, Willamina – K07323West Valley, Yakima – K04404West Vancouver – K03039Western Washington County – K19945White Center – K16315Winthrop – K03355Woodburn – K05679Yakima – K00396

Response, Signature, and Date

The year I will be serving as Lt. Governor is…(Required)

Please select the year below.

2026-20272027-20282028-2029

I agree to the duties and responsibilities of Lt. Governor.(Required)

Yes

No

Signature

Date(Required)

Valuable Skills

Please list skills you have that you would consider sharing at the District level. i.e. teaching, event planning, fundraising, membership coaching.

Submit