CLUB COACH

APPOINTMENT

Verizon Toastmasters @ RMZ

Club Name ____________________________________________  Club Number _____________________ 
06539401 District ____________
120

Name______________________________________
Sivapriya J.C. Name________________________________________

Member Number_____________________________
7021064 Member Number______________________________

Address__Global
___________________________________
Infocity Address______________________________________

City________________________________________
Chennai City_________________________________________

State/Province_______________________________
Tamil Nadu State/Province________________________________

Country____________________________________
India Country______________________________________

Postal Code_________________________________
600096 Postal Code___________________________________

Home Club Number__06596709

_________________________ Home Club Number____________________________

A club must have at least one but not more than 12 members to qualify for a club coach appointment.

Up to two club coaches may be appointed per club. A club coach is recognized and receives credit if the club to which
he or she is assigned achieves Distinguished Club or better by June 30 of the current year or by the following June 30.
Coaches may not be a member of the club at the time of the appointment.

________________________________   Approved by: ______________________________________________________________

APPOINTMENT DATE DISTRICT DIRECTOR OR CLUB GROWTH DIRECTOR

4This form must be submitted to World Headquarters at the time of appointment.

4A club must have at least one but not more than 12 members when a coach is appointed, and the coach cannot be a
member of that club until their appointment request has been processed.

4This form can be submitted by email to clubcoach@toastmasters.org

Rev. 5/2016  Item 1152