®
Gavel Club
An affiliate of Toastmasters International
Request for Certification
TO: New Clubs
Toastmasters International
Englewood, Colorado
The undersigned, as duly authorized representatives of the applicant club, hereby apply for a Certificate of
Affiliation with Toastmasters International, as an established and officially recognized Gavel Club, and request that
a Certificate of Affiliation granting status and privileges of a Gavel Club and the use of the name shall be issued.
In support of this request, and as conditions upon which favorable action shall be based, we submit the following
statements and supporting evidence.
1. This club claims qualification for acceptance as a Gavel Club because the club may not be chartered as a
Toastmasters club for the following reasons:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
2. The Representatives of Record of this club are:
President: ______________________________________________________________________________
Address: ______________________________________________________________________________
______________________________________________________________________________
Secretary: ______________________________________________________________________________
Address: ______________________________________________________________________________
______________________________________________________________________________
Counselor: ______________________________________________________________________________
Representative of Organization or Institution
Address: ______________________________________________________________________________
______________________________________________________________________________
(NOTE: The World Headquarters of Toastmasters International should be notified promptly of any changes because
club correspondence can only be accepted from accredited representatives.)
3. This club has ___________________ members.
4. Meetings are held at ___________________ (time) on _________________________________ (day of week)
at ________________________________________________________________________________ (place).
5. This club shall be known as __________________________________________________________________
Gavel Club of _____________________________________________________________________________
City State
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6. Our club has reviewed the Bylaws of Toastmasters International and we affirm that the policies and principles
of our club are consistent with the principles and ideals of Toastmasters International.
7. The representative of the organization or institution who will counsel the club and encourage its continuity,
stability and compliance with the policies of the institution or organization and Toastmasters International is:
___________________________________________
Name
___________________________________________
Title
8. The club intends to use and apply the program, methods, procedures, materials and services of Toastmasters
International insofar as its circumstances permit.
9. The club accepts the financial arrangements adopted to its needs and abilities and consistent with the
interests of Toastmasters International, as agreed upon between Toastmasters International and this club.
10. The club has adopted a Constitution and Bylaws adapted to its circumstances and in harmony with the basic
principles of Toastmasters International.
11. Certification Fee of $ ____________________ is transmitted herewith together with other fees for services
and materials requested, in accordance with the agreement regarding them.
12. The club agrees that failure to submit reports or to comply with the basic principles of Toastmasters Interna-
tional may result in cancellation of its Certificate of Affiliation.
SUBMITTED FOR APPLICANT CLUB: ____________________________________________ President
____________________________________________ Secretary
______________________ ____________________________________________ Counselor
Date of Application Club Advisor Representing Institution or Organization
I have read the foregoing statements to which the representatives of this special group have subscribed. As the
duly authorized representative, and on behalf of the institution or organization (if any) with which this special
group is identified, I subscribe to the following statements:
The policies and programs of this club are consistent with the policies and regulations of the organization or
institution with which this group is identified; and
As a Gavel Club, affiliated with Toastmasters International, this group has the approval of this organization or
institution with which it is identified.
___________________________________________
Name and Title
___________________________________________
Name of Institution or Organization
____________________________
Date
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