2018-20 Chapter Officers’ Leadership Training June 2, 2018 ● Pineville Convention Center, 2727 Monroe Hwy, Pineville Please type or print. Make check payable to: Epsilon State. Deadline: May 11, 2018 Mail to: Martha Turner, 2429 Clearbrook Way, Haughton, LA 71037 For New Chapter Officers Chapter:_________________________ District: _______________ (If anyone is substituting for an officer, please write substitute beside the office with the substitute’s information written below.) Chapter President (Name) Mailing Address Email Phone Special Needs Attending Lunch (Circle) Yes No Chapter 1st Vice President (Name) Mailing Address Email Phone Special Needs Attending Lunch (Circle) Yes No Chapter Second Vice President (Name) Mailing Address Email Phone Special Attending Lunch (Circle) Yes No Chapter Treasurer (Name) Mailing Address Email Phone Special Needs Attending Lunch (Circle) Yes No Registration Fees for Chapter Officers Attending 1 2 3 4 $ ($15 per attendee) Luncheon Fees 1 2 3 4 $ ($17 per attendee) Total Amount Enclosed $ For State Officers/Personnel, District Directors, & Leadership Development Committee Members Only Name Title Mailing Address Email Phone Number Special Needs Attending Lunch (Circle) Yes No Registration Fee $ ($15 per attendee) Luncheon Fee $ ($17 per attendee) Total Amount Enclosed $
2018-20 Chapter Officers’ Leadership Training ● June 2, 2018 Pineville Convention Center, 2727 Monroe Hwy, Pineville Please type or print. Make check payable to: Epsilon State. Deadline: May 11, 2018 Mail to: Martha Turner, 2429 Clearbrook Way, Haughton, LA 71037 For New Chapter Officers Chapter:_________________________ District: _______________ (If anyone is substituting for an officer, please write substitute beside the office with the substitute’s information written below.) Chapter President (Name) Mailing Address Email Phone Special Needs Attending Lunch (Circle) Yes No Chapter 1st Vice President (Name) Mailing Address Email Phone Special Needs Attending Lunch (Circle) Yes No Chapter Second Vice President (Name) Mailing Address Email Phone Special Attending Lunch (Circle) Yes No Chapter Treasurer (Name) Mailing Address Email Phone Special Needs Attending Lunch (Circle) Yes No Registration Fees for Chapter Officers Attending ($15 per attendee) 1 2 3 4 $ Luncheon Fees ($17 per attendee) 1 2 3 4 $ Total Amount Enclosed $ For State Officers/Personnel, District Directors, & Leadership Development Committee Members Only Name Title Mailing Address Email Phone Number Special Needs Attending Lunch (Circle) Yes No Registration Fee ($15 per attendee) $ Luncheon Fee ($17 per attendee) $ Total Amount Enclosed $
dkg-new-chapter-officers-registration-form-2018-2020.docx