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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