I hereby state that I understand clearly the qualification, duties and responsibilities of the office of district governor as set forth in the RI Bylaws and that I am fully qualified for said and willing and able, physically and otherwise, to assume and fulfill the duties and responsibilities of that office and to perform them faithfully, Further, I have read and agreed to abide by the district governor code of ethics, as detailed in the Rotary Code of Policies, I understand that if selected, I Must attend, for their full duration, the governors-elect training seminar in my zone and the International Assembly to be held the Rotary year before taking office. I have read this form in its entirety and certify that all the information provided on this form is true and correct.
The candidate herein mentioned is a member in good standing of the Rotary Club of _________________ The club further attests that this member has been duly suggested for the office of district governor under RI Bylaws 13.020.4 and meets that qualification as specified in RI Bylaws 15.070 and that the club membership information on this form is accurate.