Long Service Certificate Request

Chairman:  Mike Gould
Certificates for Club Anniversaries or Long Term Member Service (defined as 20+ years) may be obtained from your CGCI Certificates Chairman.
Complete and submit the form below
It will automatically be sent to the Chairman
Please allow 4 weeks for processing, shipping and handling

Please provide full name to appear on the certificate
Date the certificate is to be presented
Name of club or district requesting the certificate
Provide name and complete mailing address (PO Box or Street, City and Zip Code +4)