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Revised 8/2016
Ruritan Club
Name of New Club:________________________________________________________________________________
Ruritan District:_ __________________________________________________________________________________
Date of Charter Night:______________________________________________________________________________
Town/City where Charter Meeting will be held: _ _________________________________________________________
Time of the Meeting:_______________________________________________________________________________
Location:_ _______________________________________________________________________________________
Temporary President:_ _____________________________________________________________________________
Address: _ ____________________________________________________________________________________
_ ____________________________________________________________________________________________
Phone : (___) ________________________ E-mail: ______________________________________________
Temporary Secretary:_ _____________________________________________________________________________
Address: _ ____________________________________________________________________________________
_ ____________________________________________________________________________________________
Phone: (___) ________________________ E-mail: ______________________________________________
Sponsoring Club:_ ________________________________________________________________________________
Distinguished Ruritan Member’s (DRM) name: _ _________________________________________________________
Address: _ ____________________________________________________________________________________
Phone: (___) ________________________ E-mail: ______________________________________________
Club: _ _______________________________________________________________________________________
(person most responsible for organizing this new club)
Charter Night Information
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