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Club Representative Form

* required fields marked by asterisk

Club Name *

Travel Coordinator 		 
Name
Address
City
Zip Code
Phone
Email

Club President		  
Name
Address
City
Zip Code
Phone
Email

Club Vice President		  
Name
Address
City
Zip Code
Phone
Email

Club Treasurer		  
Name
Address
City
Zip Code
Phone
Email


List three (3) club representatives who have the authority to cast votes at any B&WNYJSL meeting. Only the listed names below will be eligible to vote.
 
Representative 1
Representative 2
Representative 3
   
Submitted By: *
E-mail Address:
(for email confirmation)		 *
 
 
 

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