OHIO DISTRICT OPTIMIST GOVERNOR ELECT NOMINATION FORM Name:   Address:     Home No.: Work No.:     Fax No.: Cell No.:   Email Address: Employer's Name (Company):   May we contact place of business?: Yes No     Self-Employed / Retired?: Yes No     Date of Birth: (mm/dd/yy) Age:     Partner's Name:     Children's Names: Home Optimist Club Name:   Year and Club where you served as President:        Year    Club Name   Year and Zone Served as Lt. Governor:        Year          Zone   Would anything keep you from traveling around the state and out of state for training/Conventions? Yes No   I acknowledge that a current letter from my home club in support of my candidacy is required to complete this application. Yes No   Year and position held as District Chair: Year     Position     Do you know that this is an eight (8) year commitment? Yes No Optimist Awards & Honors:     Why do you want to be Governor of the Ohio District?     Note: If you are self-employed or retired the candidate does not need to submit a letter confirming his/her ability to devote necessary/required time to perform duties of Governor.