Chapter Profile Update Form

Note: Mailing address, phone numbers, & e-mail are not needed & please do not include councillors or alt. councillors.

Form Download (PDF) >>

 

Chapter 

Effective Date 

Reason for Change (Election, resignation, other - please specify)



Date of Next Election  


New Officers

President   

President Elect 

Vice President

Secretary

Treasurer 

Immediate Past President

Board of Directors 

Note: Do not include years in office as everyone is listed for one year due to numerous officer changes.

 

 

  

 

  

 

 

  

 

 

 

  

 

State Legislative Liaison  

Current Committee Chairs

Note: If your chapter has committees that are not listed, please add them.

ITLS

Bylaws  

Education

EMS  

Finance

Government Affairs  

Legislative

Long Range Planning

Membership

Practice Management 

Public Affairs

Reimbursement

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