Chapter Name: (*)
Please enter your chapter's name.
Chapter Acronym: (*)
Please enter your chapter's acronym.
States within your chapter: (*)
Please enter the states within your chapter.
Chapter Street Address or PO Box: (*)
Please enter your chapter's street address or PO Box.
Chapter City: (*)
Please enter your chapter's city.
Chapter State: (*)
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Chapter Zip Code: (*)
Please enter your chapter's zip code.
Chapter Email (if applicable):
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Chapter Website (if applicable):
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Chapter Tax ID Number (EIN): (*)
Please enter your chapter's Tax ID Number (EIN).
Chapter gross revenue received between
Jan. 1, 2016 - Dec. 31, 2016: (*)
Please enter your chapter's gross revenue received between Jan. 1, 2014 - Dec. 31, 2015.
Chapter Dues Amount: (*)
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Chapter Zip Code Ranges (for dues billing purposes): (*)
Please enter the zip code ranges for your chapter.
Number of business meetings held in 2016: (*)
Please enter the number of business meetings held in 2014.
Number of educational meetings held in 2016: (*)
Please enter the number of educational meetings held in 2014.
List the names, dates, and brief descriptions of your meetings.
At least two meetings are required every calendar year. (*)
Please list the names, dates, and brief descriptions of your meetings. At least two meetings are required every calendar year.
Current number of chapter members: (*)
Please enter the current number of chapter members.
Upload current chapter bylaws (with changes highlighted):
Please upload your current chapter bylaws with changes highlighted. File types .doc, .docx, or .pdf only.
If you would like assistance regarding any aspect of
chapter operations, please state your request here:
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Please list your new leaders
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Please list leaders stepping down
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President First Name: (*)
Please enter the Chapter President's first name.
President Last Name: (*)
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President Email Address: (*)
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President-Elect First Name:
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President-Elect Last Name:
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President-Elect Email Address:
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Secretary First Name:
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Secretary Last Name:
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Secretary Email Address:
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Treasurer First Name:
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Treasurer Last Name:
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Treasurer Email Address:
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Person completing this report: (*)
Please enter the name of the person completing this report.
Email address of person completing this report: (*)
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