Chapter Leadership Reporting Form

NIGP Chapter Leadership Reporting Form

To be completed by January 31.

Board Policy and the Chapter Operating Framework (Affiliation Agreement) requires that a minimum, the President, Vice President and either the Secretary or Treasurer are required to hold an Agency or Individual NIGP Membership.
REMINDER: When completing this form make sure to TAB from field to field and DO NOT hit enter.
If you would like to add additional individuals to this list, please email them to Jsteffan@nigp.org directly
The individuals on this list will receive the monthly Leaders-in-the-Loop and will be invited to the quarterly Chapter Leader Calls.
The Chapter contact and address posted on the NIGP website will be that of the current Chapter President

This form must be submitted in order for a chapter to be eligible for a Chapter Performance Standard SEAL or an Outstanding Chapter Award.

Chapter Name

Chapter Preferred Mailing Address

Chapter Web Address

Chapter Leader Term Begins

(Example 1/1/2016)

Chapter Leader Term Ends

(Example 12/31/2016)

President

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

Vice President

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

First Vice President

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

Secretary

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

Treasurer

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

Professional Development and/or Education Chair

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

Seminar Coordinator

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

Membership Chair

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

Communication/Marketing Chair

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

Webmaster

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

Website Admin

Name

First Name

Last Name

Name

First Name

Last Name

Name

First Name

Last Name

Name

First Name

Last Name

Name

First Name

Last Name

Name

First Name

Last Name

Name

First Name

Last Name

Additional Emails Requested

SHOULD YOU HAVE ANY OTHER LEADERS WITHIN THE CHAPTER OR BOARD THAT YOU WOULD LIKE TO RECEIVE CHAPTER RELATED EMAILS AND NOTICES, PLEASE ADD THEM HERE (DO NOT ADD PAST PRESIDENTS, THEY WILL AUTOMATICALLY BE ADDED TO THE CONTACT LIST. )

Chapter Position

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

Chapter Position

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

Chapter Position

Name

First Name

Last Name

Certification

Title

Agency

Mailing Address

City

State/Province

Zip/Postal Code

Phone

Please print a copy of this form prior to submitting for your chapter records.