CREDENTIALS FORM

CREDENTIALS FORM
NJDAR 134th Annual State Conference, April 24 & 25, 2026
CHAPTER:
CODE:
Number of members paid by December 1, 2025:
Indicate First and Last Names
DELEGATE 1/REGENT: CHAPTERS WITH 12-19 MEMBERS: (for chapters with 12-19 members, Regent is Delegate.)
Delegate 1/Regent:
National Number:
Address:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
ALTERNATES FOR DELEGATE 1/REGENT:
Alternate 1:
National Number:
Email:
example@example.com
Alternate
National Number:
Email:
example@example.com
DELEGATE 2: CHAPTERS WITH 20-49 MEMBERS:
Delegate 2:
National Number:
Email:
example@example.com
ALTERNATES FOR DELEGATE 2:
Alternate 1:
National Number:
Email:
example@example.com
Alternate 2:
National Number:
Email:
example@example.com
DELEGATE 3: CHAPTERS WITH 50-99 MEMBERS:
Delegate 3:
National Number:
Email:
example@example.com
ALTERNATES FOR DELEGATE 3:
Alternate 1:
National Number:
Email:
example@example.com
Alternate 2:

National Number:
Email:
example@example.com
DELEGATE 4: CHAPTERS WITH 100-150 MEMBERS:
Delegate 4:
National Number:
Email:
example@example.com
ALTERNATES FOR DELEGATE 4:
Alternate 1:
National Number:
Email:
example@example.com
Alternate 2:
National Number:
Email:
example@example.com
This is to certify that the delegates and alternates to the NJDAR 134th Annual State Conference were elected on the day of 202 and in case of disability or absence, the alternates listed have full power to act in all matters that may come before the voting body of the Annual State Conference.
SIGNED:
Regent:
Treasurer:
In the event the office of Regent and/or Treasurer is vacant or absent, the signature of the next highest officer is permissible.
NOTE: Should it be determined that a delegate is unable to attend, written notice I advance of the conference must be submitted to the Credentials Chair. Email correspondence is acceptable.
DEADLINE/POSTMARK DATE: MARCH 23, 2026
SUBMIT COMPLETED FORM VIA EMAIL OR USPS TO:
Sarah Slack, Credentials Chair
136 Buttonwood Ln
Cinnaminson, NJ 08077
sarahslack13@gmail.com
Should be Empty: