District Officer Certification

Email of Person Submitting Report

example@example.com

List the address where Legion-related mail should be sent. Please provide all officers’ personal mailing addresses, email addresses, as opposed to a Post address. It is important that we can contact all officers at their preferred personal addresses.

District #: *

Legion Year Start*

Legion Year End*

NoYes

Name*

ID Number*

Address*

Street Address

Street Address Line 2

City & State

Zip Code

Email address*

example@example.com

Preferred Phone Number*

Date of Enlistment*

Date

Date of Discharge*

Date

Branch of Service*

NoYes

Name*

ID Number*

Address*

Street Address

Street Address Line 2

City & State

Zip Code

Email address*

example@example.com

Preferred Phone Number*

Date of Enlistment*

Date

Date of Discharge*

Date

Branch of Service*

NoYes

Name*

ID Number*

Address*

Street Address

Street Address Line 2

City & State

Zip Code

Email address*

example@example.com

Preferred Phone Number*

Date of Enlistment*

Date

Date of Discharge*

Date

Branch of Service*

NoYes

Name*

ID Number*

Address*

Street Address

Street Address Line 2

City & State

Zip Code

Email address*

example@example.com

Preferred Phone Number*

Date of Enlistment*

Date

Date of Discharge*

Date

Branch of Service*

NoYes

Name*

ID Number*

Address*

Street Address

Street Address Line 2

City & State

Zip Code

Email address*

example@example.com

Preferred Phone Number*

Date of Enlistment*

Date

Date of Discharge*

Date

Branch of Service*

NoYes

Name*

ID Number*

Address*

Street Address

Street Address Line 2

City & State

Zip Code

Email address*

example@example.com

Preferred Phone Number*

Date of Enlistment*

Date

Date of Discharge*

Date

Branch of Service*

NoYes

Name*

ID Number*

Address*

Street Address

Street Address Line 2

City & State

Zip Code

Email address*

example@example.com

Preferred Phone Number*

Date of Enlistment*

Date

Date of Discharge*

Date

Branch of Service*

NoYes

Name*

ID Number*

Address*

Street Address

Street Address Line 2

City & State

Zip Code

Email address*

example@example.com

Preferred Phone Number*

Date of Enlistment*

Date

Date of Discharge*

Date

Branch of Service*

NoYes

Name*

ID Number*

Address*

Street Address

Street Address Line 2

City & State

Zip Code

Email address*

example@example.com

Preferred Phone Number*

Date of Enlistment*

Date

Date of Discharge*

Date

Branch of Service*

NoYes

Name*

ID Number*

Address*

Street Address

Street Address Line 2

City & State

Zip Code

Email address*

example@example.com

Preferred Phone Number*

Date of Enlistment*

Date

Date of Discharge*

Date

Branch of Service*

I hereby certify that each of the above officials is eligible to membership in The American Legion and has the consequent right to serve in an official capacity.

Name of Person Submitting Report

Signature *

Date*

Date

Department of Washington

District Commander

District Senior / 1st Vice Commander

District Junior / 2nd Vice Commander

District Adjutant

District Service Officer

District Chaplain

District Finance Officer

District Sergeant-At-Arms

District Historian

District Judge Advocate