State of Mississippi Chapter Delegate Form 36
NOTE: Form must be approved by Chapter Basileus and submitted by the Chapter KRS. All Chapter Delegates should be submitted on the same form.
Name of Chapter
*
Chapter Keeper of Records and Seal
*
Chapter KRS Email
example@example.com
Chapter Basileus
Chapter Basileus Email
example@example.com
Chapter Delegates
*
Full Name
Email Address
Phone Number
Control Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Submit
Should be Empty: