Please complete each question on this form. The submission deadline is September 18, 2026. Please submit your club's Distinguished Rotarian of the Year in the area of COMMUNITY SERVICE and include ONLY THE ROTARIAN'S SERVICE FOR THE PERIOD OF July 1, 2025 through June 30, 2026.

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1. Rotary Club Contact Information (Required.)

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2. Name of your Club's Nominee: (Required.)

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3. Please describe Rotarian's activities in the area of COMMUNITY SERVICE for the period specified above. (Required.)

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