Please complete each question on this form. The submission deadline is April 1, 2018. Please submit your club's Distinguished Rotarian of the Year in the area of CLUB SERVICE and include ONLY THE ROTARIAN'S SERVICE FOR THE PERIOD OF April 1, 2017 through March 31, 2018.

* 1. Rotary Club Contact Information

* 2. Name of your Club's Nominee:

* 3. Please describe Rotarian's activities in the area of CLUB SERVICE for the dates specified above.