Department of Washington Certification of District Delegates 2026 National Convention
District #:
Rows
Membership #
First Name
Last Name
Delegate(Y/N)
Alternate Delegate(Y/N)
1
2
3
4
5
6
7
8
9
10
11
NOTE: No payments should be submitted with this form. All attendees must register and
pay using the National Convention Registration form.
Submitter Name/Title
Date
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