Delegate & Alternate Delegate Form
Complete this form by December 31st.
Any delegate appointed after December 31st will not receive credit for eligibility.
Name of Delegate
*
First Name
Last Name
Chapter #
*
Delegate Phone Number
*
Format: (000) 000-0000.
Delegate Email
*
Name of Alternate Delegate
*
First Name
Last Name
Alternate Phone Number
*
Format: (000) 000-0000.
Date Submitted
-
Month
-
Day
Year
Submit
Should be Empty: