2026 Affiliate Information and Delegate Sheet
Each organization has 5 votes (President and 4 delegates)
Affiliate Information
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
President
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid mobile phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Delegates
Delegate 2
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid mobile phone number.
Format: (000) 000-0000.
Delegate 3
*
First Name
Last Name
Phone Number
*
Please enter a valid mobile phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Delegate 4
*
First Name
Last Name
Phone Number
*
Please enter a valid mobile phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Delegate 5
*
First Name
Last Name
Phone Number
*
Please enter a valid mobile phone number.
Format: (000) 000-0000.
Email
*
example@example.com
President’s Signature
*
Date
*
-
Month
-
Day
Year
Date
Hour Minutes
2026 Dues Payment Method please check one
*
Check $100 payable Grand Council of United Emerald Societies Inc Post Office Box 38 Atlantic Beach, NY 11509 Press Submit
Zelle $100 to info@gcues.org-The Grand Council of United Emerald-Long Beach, NY Press Submit
Express check out Apple Pay and Google or Credit/Debit, Pay $100- scan QR code . Press Submit
Submit
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