EmailMe Form - MNWT Living & Learning Certification

Your Email *

Date *

MM / DD / YYYY

District *

Chapter *

Submitter Name *

First Last

Phone *

### - ### - ####

Self-Improvement *

Take an educational course, attend a seminar, or take a Personal Enrichment Program (PEP).

Write an essay or a differnt extended writing.

Give a speech or planned presentation; should be 4-6 minutes in length.

Participate in a career development activity.

Read a self-improvement book.

Try something new – something outside your comfort zone

Other

You must select a minimum of two (2) items in this section

Educational Course, Seminar or PEP Topic *

Educational Course, Seminar or PEP Date *

MM / DD / YYYY

Essay or Extended Writing Topic *

Essay or Extended Writing Date *

MM / DD / YYYY

Speech or Presentation Topic *

Speech or Presentation Date *

MM / DD / YYYY

Career Development Date *

MM / DD / YYYY

Self Improvement Book Title *

Self Improvement Book Date *

MM / DD / YYYY

Something New Description *

Something New Date *

MM / DD / YYYY

Self Improvement Other Topic/Title/Description

Self Improvement Other Date

MM / DD / YYYY

Civic Growth *

Be registered to vote and vote in a governmental election at the national, state, or city level.

Attend a public meeting with elected officials or write a letter to an elected official.

Participate in a park cleanup, adopt-a-highway, or recycling program.

Visit a historical monument or landmark.

Be a member of a different organization.

Learn about American history by reading a book, listening to a speaker, or watching a documentary.

Research a current event or issue and educate someone else about it.

Other

You must select a minimum of two (2) items in this section

Voter Registration Date *

MM / DD / YYYY

Public Meeting Date *

MM / DD / YYYY

Clean-Up Program Date *

MM / DD / YYYY

Historical Monument or Landmark Place *

Historical Monument or Landmark Date *

MM / DD / YYYY

Other Organization Name *

Other Organization Date *

MM / DD / YYYY

Historic Learning Topic *

Historic Learning Date *

MM / DD / YYYY

Current Event Topic *

Current Event Date *

MM / DD / YYYY

Civic Growth Other Topic/Title/Description *

Civic Growth Other Date *

MM / DD / YYYY

Spiritual Growth *

Attend a fellowship service at a national, state, district, or local event.

Learn about a major religion by reading a book, listening to a speaker, or watching a documentary.

Spend some time reflecting. Could be daily reflection or meditation.

Tell someone about a life changing experience.

Take an active role in a program or worship service at your place of worship.

Lead a fellowship activity.

Other

You must select a minimum of two (2) items in this section

Fellowship Service Event *

Fellowship Service Date *

MM / DD / YYYY

Religious Learning Topic *

Religious Learning Date *

MM / DD / YYYY

Reflection/Meditation Date *

MM / DD / YYYY

Life Changing Experience Topic *

Life Changing Experience Date *

MM / DD / YYYY

Worship Service Role *

Worship Service Date *

MM / DD / YYYY

Fellowship Activity *

Fellowship Activity Date *

MM / DD / YYYY

Spiritual Growth Other Topic/Title/Description *

Spiritual Growth Other Date *

MM / DD / YYYY

Growth through Family and Friends *

Attend or host a special activity or event honoring a friend or family member.

Create or continue a family tradition.

Learn something from or teach something to one of your friends or family members.

Learn about family or friendship relationships or dynamics by reading a book or attending a course.

Create or update a family history

Other

You must select a minimum of two (2) items in this section

Special Activity Event *

Special Activity Date *

MM / DD / YYYY

Family Tradition *

Family Tradition Date *

MM / DD / YYYY

Learning Experience Topic *

Learning Experience Date *

MM / DD / YYYY

Family Dynamics Topic *

Family Dynamics Date *

MM / DD / YYYY

Family History Topic *

Family History Date *

MM / DD / YYYY

Growth through Family and Friends Other Topic/Title/Description *

Growth through Family and Friends Other Date *

MM / DD / YYYY