Officer Report Form

2009-2010

Please complete this form and return it to the National Office by mail, fax, or online no later than July 1st. Even if the chapter officers for 2009-2010 hold the same positions as they did in 2008-2009, we still need to have a completed form for our records.

Thank you for your timely cooperation.

Chapter Information
Chapter Name
Chapter Number
Chapter Website
ZIP Code of Chapter Meeting Space
		*For information on how to obtain a free chapter web page through the AGO, please contact jem@agohq.org at AGO National Headquarters.
Dean
Name
Mailing Address
City
State
Zip
Work Phone
Home Phone
Fax
E-Mail
Sub-Dean
Name
Mailing Address
City
State
Zip
Work Phone
Home Phone
Fax
E-Mail
Treasurer
Name
Mailing Address
City
State
Zip
Work Phone
Home Phone
Fax
E-Mail
Registrar
Name
Mailing Address
City
State
Zip
Work Phone
Home Phone
Fax
E-Mail
Secretary
Name
Mailing Address
City
State
Zip
Work Phone
Home Phone
Fax
E-Mail
Newsletter Editor
Name
Mailing Address
City
State
Zip
Work Phone
Home Phone
Fax
E-Mail
Education Coordinator
Name
Mailing Address
City
State
Zip
Work Phone
Home Phone
Fax
E-Mail
Professional Development Coordinator
Name
Mailing Address
City
State
Zip
Work Phone
Home Phone
Fax
E-Mail
Membership Coordinator
Name
Mailing Address
City
State
Zip
Work Phone
Home Phone
Fax
E-Mail
Webmaster
Name
Mailing Address
City
State
Zip
Work Phone
Home Phone
Fax
E-Mail
Miscellaneous
		Who should receive membership mailings from the AGO National Membership Department?

Additional Officers
Sender Information
Sender's Name
The following two fields must be completed or an error message will result. If an error message does occur, please press your browser's back button to restore the form.
Sender's E-Mail (Required)
Region - (Required)
Additional Information or Comments
Comments
Please print this form or copy it into your word processor before pressing “Send ORF.” Important: Please be sure to select your region and provide your e-mail address before pressing “Send ORF.” If you do not select your region and provide your e-mail address, you will receive an error message, the form will be cleared, and your entries will be lost. After sending the fully completed ORF, pressing the “back” button in your browser should restore the completed form.