Service Unit Delegates & Alternates

The deadline to send in delegate information is within ten days of the election.

First and Last Name *

Service Unit Name and Number *

Name of Service Unit Administrator *

Mailing Address *

Please provide mailing address so we can send your delegate packet to the appropriate place.

Phone Number *

Phone

Email Address *

Delegate *

Alternate *

Adult

Girl

Must be at least 14 years of age

Will you be traveling more than 2 hours to Charleston for the Annual Meeting? *

Today's Date *

mm/dd/yyyy

Date that Service Unit Election was held *

mm/dd/yyyy

*

Send me a copy of my responses

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