NIGP - Chapter Officer Data Form

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Annual Chapter Officer Data Reporting Form
Complete by January 31, 2009

Complete and submit this entire form annually regardless of chapter officer terms and submit form with changes whenever chapter officers or their contact information need updating.

Note: Required fields in red.

1. ABOUT YOUR CHAPTER:

Chapter Name:
Chapter URL (Web Address):	(Example: www.nigp.org)
Chapter Officer Term Begins:	(Example: 01/01/2008)
Chapter Officer Term Ends:	(Example: 12/31/2010)
Preferred Chapter Mailing Address1:
Address2:

City:		State/Province:
Zip:		Country:

Chapter Board Policy requires that at a minimum, the President, Vice President, and one other Chapter Officer are required to hold a NIGP National Agency or Individual membership.

2. NIGP CHAPTER OFFICERS:

Please complete information on all chapter officer positions applicable to your chapter.

President:

First Name:
M.I.
Last Name:
Certifications:	(Example: CPPO)
Title:
Department:
Agency:
Preferred Address1:
Address2:
City:
State/Province:
Zip:
Country:
Phone:
Fax:
Email:

Vice President:

First Name:
M.I.:
Last Name:
Certifications:	(Example: CPPO)
Title:
Department:
Agency:
Preferred Address1:
Address2:
City:
State/Province:
Zip:
Country:
Phone:
Fax:
Email:

Secretary:

First Name:
M.I.:
Last Name:
Certifications:	(Example: CPPO)
Title:
Department:
Agency:
Preferred Address1:
Address2:
City:
State/Province:
Zip:
Country:
Phone:
Fax:
Email:

Treasurer:

First Name:
M.I.:
Last Name:
Certifications:	(Example: CPPO)
Title:
Department:
Agency:
Preferred Address1:
Address2:
City:
State/Province:
Zip:
Country:
Phone:
Fax:
Email:

CHAIRS
Education (ProD) Chairperson:

First Name:
M.I.:
Last Name:
Certifications:	(Example: CPPO)
Title:
Department:
Agency:
Preferred Address1:
Address2:
City:
State/Province:
Zip:
Country:
Phone:
Fax:
Email:

Seminar Coordinator:

First Name:
M.I.:
Last Name:
Certifications:	(Example: CPPO)
Title:
Department:
Agency:
Preferred Address1:
Address2:
City:
State/Province:
Zip:
Country:
Phone:
Fax:
Email:

Chapter Membership:

First Name:
M.I.:
Last Name:
Certifications:	(Example: CPPO)
Title:
Department:
Agency:
Preferred Address1:
Address2:
City:
State/Province:
Zip:
Country:
Phone:
Fax:
Email:

Chapter Newsletter Editor/Marketing:
First Name:
M.I.:
Last Name:
Certifications:	(Example: CPPO)
Title:
Department:
Agency:
Preferred Address1:
Address2:
City:
State/Province:
Zip:
Country:
Phone:
Fax:
Email:

Please review your information prior to selecting Submit.

Questions? Please contact chapters@nigp.org

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Phone: 703-736-8900 � Fax: 703-736-2818
Toll-Free: 800-FOR-NIGP