|
Name of Region |
|
|
PLEASE PRINT OR TYPE |
|
President |
|
AACA # |
|
|
Address |
|
|
(show complete mailing address
including zip code) |
|
Day Phone # |
(
) |
Home Phone # |
(
) |
|
Email |
|
|
Vice President |
|
AACA # |
|
|
Address |
|
|
Telephone # |
(
) |
Email |
|
|
Secretary |
|
AACA # |
|
|
Address |
|
|
Telephone # |
|
Email |
|
|
Treasurer |
|
AACA # |
|
|
Address |
|
|
Telephone # |
|
Email |
|
|
Name of Region Publication |
|
|
Frequency of Region Publication |
|
|
Name of Editor |
|
AACA # |
|
|
Address |
|
|
Email |
|
|
Name of Club Legislative Representative |
|
|
Address |
|
|
Telephone # |
|
Email |
|
|
|
|
|
|
MAIL TWO COPIES OF THOS COMPLETED FORM TO AACA
NATIONAL HEADQUARTERS
501 WEST GOVERNOR ROAD, PO BOX 417, HERSHEY PA 17033 |
|
Please note: all names appearing on
this form must be paid members of the AACA. all names and
addresses must appear exactly as the information on the
membership card. If different, please indicate change of
address. |
|
Total Number of Region Members
|
Signed |
|
|
Date of Region Election
|
Title |
|
|
|
Date |
|
National
Headquarters