New Z Club or Golden Z Club Authorization
Please type or
print
This form should be completed by the president of the sponsoring Zonta club and sent to Zonta
International Headquarters along with the charter registration fee of $25.00 US Dollars.
Name of the sponsoring Zonta Club:
District number:
We wish to sponsor a:
Area number:
Z Club
Club number:
Golden Z Club
(please check one)
Proposed Name of New Z Club / Golden Z Club: _
(above name will be printed on the charter)
Z Club / Golden Z Club Mailing Address:
Telephone:
Fax:
Email address:
Name of Z Club / Golden Z Club Advisor:
Address:
Telephone:
Fax:
Email address:
Sponsoring Zonta Club President’s Signature:
Date:
Note: All correspondence and communication between Zonta International Headquarters and a Z or Golden Z
club should be routed through the Z Club Chairman or current president of the sponsoring Zonta club.
Complete the following Information for each Z or Golden Z Club
member:
(Use Additional Sheets if
necessary)
Name:
Address:
Age:
City:
State:
Country:
Telephone:
Grade:
Postal Code:
Z/Golden Z Club Office Held:
Email Address:
Name:
Address:
Age:
City:
State:
Country:
Telephone:
Grade:
Postal Code:
Z/Golden Z Club Office Held:
Email Address:
Name:
Address:
Age:
City:
State:
Country:
Telephone:
Grade:
Postal Code:
Z/Golden Z Club Office Held:
Email Address:
Name:
Address:
Age:
City:
State:
Country:
Telephone:
Grade:
Postal Code:
Z/Golden Z Club Office Held:
Email Address:
Name:
Address:
Age:
City:
State:
Country:
Telephone:
Grade:
Postal Code:
Z/Golden Z Club Office Held:
Email Address:
Name:
Address:
Age:
City:
Grade:
State:
Country:
Postal Code:
Telephone:
Z/Golden Z Club Office Held:
Email Address:
Name:
Address:
Age:
City:
State:
Country:
Telephone:
Grade:
Postal Code:
Z/Golden Z Club Office Held:
Email Address:
Name:
Address:
Age:
City:
State:
Country:
Telephone:
Grade:
Postal Code:
Z/Golden Z Club Office Held:
Email Address:
Name:
Address:
Age:
City:
State:
Country:
Telephone:
Grade:
Postal Code:
Z/Golden Z Club Office Held:
Email Address:
Name:
Address:
Age:
City:
State:
Country:
Telephone:
Grade:
Postal Code:
Z/Golden Z Club Office Held:
Email Address:
Name:
Address:
Age:
City:
State:
Country:
Telephone:
Grade:
Postal Code:
Z/Golden Z Club Office Held:
Email Address:
Name:
Address:
Age:
City:
Country:
Telephone:
Email Address:
Grade:
State:
Postal Code:
Z/Golden Z Club Office Held: