VdGSA CHAPTER APPLICATION FORM

Proposed name of Chapter _______________________________________________________

Name of Chapter Representative__________________________________________________

Address and e-mail address of Chapter Representative

_______________________________________________________________________________

_______________________________________________________________________________

Current number of members _________    How many are VdGSA members?  ___________

(please attach your membership list)

Officers and Board:

Name________________________________

Position____________________________


Name________________________________

Position____________________________


Name________________________________

Position____________________________


Name________________________________

Position____________________________


Name________________________________

Position____________________________


Do you have:  (y or n)
Bylaws?___  Articles of Incorporation?___  501(c)(3) status?___   Newsletter?___

Annual dues _______________       Yearly number of play meetings  ______________

Location of meetings ___________________________________________________________


Other Chapter activities, their frequency, and charge:

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Please use the back of this form for this and other pertinent information.