Please fill out the form completely. Any incomplete forms will be returned for any missing information. For any positions that are not being updated, please enter "no update" in the field.

State(s) *

e.g., "Florida" or "Pacific Northwest: Oregon & Washington"

Region Officers

Position

Chair

Vice Chair

Secretary

Treasurer

Other

If you chose "Other", please explain

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone or Skype Name

Email

Delegate

Delegate Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone or Skype Name

Email

Election Date

MM

DD

YYYY

Secretary

Secretary Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone or Skype Name

Email

Election Date

MM

DD

YYYY