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Zones 33-34
RLI (Rotary Leadership Institute)
HELP
DISTRICT CONFERENCE AWARD APPLICATION
Please note that you will need to complete this form in one sitting. A partial form cannot be saved.
Date:
*
Rotary Year:
*
Select One
2012-2013
2013-2014
2014-2015
2015-2016
2016-2017
2017-2018
2018-2019
2019-2020
2020-2021
2021-2022
2022-2023
Select the current Rotary year.
Award Category:
*
Select One
Club Bulletin
Club Partnership Service
Club Service
Club Social Media
Club Web Site
Community Service
Douglas A. Newton: Excellence in Communications
International Service
Public Image
Vocational Service
World Community Service (discontinued)
Youth Activities
Club Name:
*
Select One
Abingdon
Altavista
Amherst
Bedford
Blacksburg
Bluefield
Botetourt
Bridgewater
Bristol Morning,Va.-Tn.
Bristol,Va.-Tn.
Broadway-Timberville
Buena Vista
Chatham
Christiansburg-Blacksburg
Clarke County
Covington-Hot Springs
Danville
Danville-After Hours
Danville-Riverview
Elizabethton
Floyd County
Forest
Frederick County
Front Royal
Giles County
Glenvar
Greeneville
Greeneville-Morning
Harrisonburg
Harrisonburg-Massanutten
Henry County
Hillsville
Johnson City
Johnson City Evening
Johnson City, TN Morning
Kingsport
Kingsport-Downtown
Kingsport-Sunrise
Lexington
Lexington Lunch
Lexington Sunrise
Luray
Lynchburg
Lynchburg-Morning
Marion
Marion-Morning
Martinsville
Martinsville UpTown
Montgomery County
Mt. Jackson-Edinburg
Nelson County
New Market
Northern Shenandoah Valley
Pulaski
Radford (Noon)
Richlands (deleted)
Roanoke
Roanoke Valley (Roanoke)
Roanoke-Downtown
Rockingham County
Rocky Mount
Russell County
Salem
Salem-Glenvar (Use Glenvar)
Scott County
Skyline Connections
Smith Mountain Lake
Staunton
Staunton-Augusta County
Strasburg
Stuart
Tazewell
The Blue Ridge – New Generations
Tri-Cities
Unicoi County
Warren County
Washington County
Waynesboro
Waynesboro-East Augusta County
Winchester
Woodstock
Wytheville
Member First Name:
*
Enter your name here
Address:
*
Street
City
State
Postal Code
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District of Columbia
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South Carolina
South Dakota
Tennessee
Texas
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Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Email:
*
Brief Description:
*
Describe the project/activities.
Limit your response to 2800 characters (about 475 words):
Lectern Synopsis:
*
Now in the event your are selected as a winner, boil your "Brief Description" down into one or two sentences that can be used during the District Award presentation. This is limited to 500 characters (about 85 words).
Participation of Club Members:
*
What percent of club members participated in each activity?
If you have multiple activities please list them and enter a percentage for each.
Resulting Benefits:
*
Describe or list the benefits of these projects and/or activities, and indicate who were the beneficiaries –
limit your response to 1800 characters (about 300 words):
Video Link:
Use only for Club Partnership, Service, Community Service, International Service, or Youth Activities.
Upload your video to YouTube and then insert
your
YouTube Video Link
in this box
(max length, three minutes)
.
We will post your video to our District YouTube page.
Use "Additional Material or Information" only for Public Image and Club Bulletin.
Supporting Documentation is limited to TWO Items:
Note: If you have multiple pictures you can put them into a single document with descriptions.
Additional Material or Information #1:
Provide a brief description of your 1st Upload:
1st Supporting Document:
No files have been uploaded yet.
Use only for Public Image and Club Bulletin.
Upload 1st Supporting Document:
(20meg limit)
NOTE:
Do not upload any files that use an "
&
" or a "
#
" in the filename.
NOTE:
If you do not see an
[Upload]
button then your device is not compatible.
Additional Materail or Information #2:
Provide a brief description of your 2nd Upload:
2nd Supporting Document:
No files have been uploaded yet.
Use only for Public Image and Club Bulletin.
Upload 1st Supporting Document:
(20meg limit)
NOTE:
Do not upload any files that use an "
&
" or a "
#
" in the filename.
NOTE:
If you do not see an
[Upload]
button then your device is not compatible.
Please ignore this field.
* indicates required fields.
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