Official Valley Chapter Designation Form

Official Designation - Submission Form

A Designation of Association Representative may only be issued to an eligible active member of your own active member association. You may not issue a designation to any person who is not a member of your own association.
Your Association Name* designates First Name* Last Name* to be our association representative and is authorized to vote on behalf of our association on all matters brought before the Valley Chapter at the Date*Chapter meeting.

Alternates (Descending Order)
1. First Name Last Name
2. First Name Last Name
3. First Name Last Name
I, First Name* Last Name* , am currently the president of Association Name* and authorize this designation.
Date Designation Authorized:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate of Authorization
Email
example@example.com
Signature
Should be Empty: