Officer Report Form

2011-2012

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 2011-2012 hold the same positions as they did in 2010-2011, 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 Justin Storms, Membership Coordinator jstorms@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
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Sender's E-Mail (Required)
Region - (Required)
Additional Information or Comments
Comments
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