2023 Quarter 1 Contact Form

Instructions

Please provide updated contact information of your branch officers and committee chairs. THIS FORM SHOULD BE COMPLETED BY THE BRANCH PRESIDENT OR SECRETARY.
2023 Quarter 1 Contact Form

NAACP New State Conference

Section #1 - Contact Information
Position*

PresidentSecretaryOther
Name*

First NameLast Name
NAACP Unit Name*
Unit #
Unit Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone*
Please enter a valid phone number.
Fax
Please enter a valid phone number.
Email*
example@example.com
Social Media

Section #2 - Current Officers & Committee Chairs Contact Information

Current Officers & Committee Chairs Contact Information *

	Name (Last, First, MI)	Address (Street, City, State, Zip)	Email	Phone #	Branch Position
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Certify and Submit
Certification

This is to certify that the names listed above have been duly elected to represent the unit listed above based on the results of the 2022 branch elections.
Signature of Branch President or Secretary

Clear
Should be Empty: