MESI CLUB HOD, SS and Athlete Form
Please complete by December 31st
CLUB NAME
*
NAME OF PERSON COMPLETING THE FORM
*
First Name
Last Name
Email of person completing the form:
*
example@example.com
HOUSE OF DELEGATE REPRESENTATIVE (MUST BE USA REGISTERED IN GOOD STANDING)
*
First Name
Last Name
HOD REP Email
*
example@example.com
HOD REP Phone Number
*
Please enter a valid phone number.
HOUSE OF DELEGATE ALTERNATE (MUST BE USA REGISTERED IN GOOD STANDING)
*
First Name
Last Name
ALTERNATE Email
*
example@example.com
ALTERNATE Phone Number
*
Please enter a valid phone number.
SAFE SPORT REPRESENTATIVE (MUST BE USA REGISTERED AND IN GOOD STANDING)
*
First Name
Last Name
SAFE SPORT Email
*
example@example.com
SAFE SPORT Phone Number
*
Please enter a valid phone number.
TEAM ATHLETE REPRESENTATIVE (SHOULD BE AGE 15 and OVER)
First Name
Last Name
ATHLETE Email
example@example.com
ATHLETE Phone Number
Please enter a valid phone number.
Submit
Should be Empty: