CHAPTER LEADERSHIP FORM
PLEASE RETURN THIS FORM TO THE JUNIOR STATE OFFICE
IMMEDIATELY
In order to get your chapter the information you need to have a great year, we need have
accurate information about the chapter leadership. If you have not elected chapter officers yet,
return this form anyway, with the name and address of the best student contact at the school.
School Name: _________________________________________________________________
CHAPTER PRESIDENT:
Name_________________________________________________________________________
Address__________________________________________________Apt #________________
City__________________________________________State__________Zip_______________
Phone (_________)_________________________Graduation Year_____________________
E-Mail________________________________________________________________________
____Official Chapter President
____Best Student Contact
TEACHER ADVISOR:
Name_________________________________________________________________________
School Address________________________________________________________________
City__________________________________________State__________Zip_______________
School Phone (______)______________________Home Phone (Optional)______________
E-Mail________________________________________________________________________
OTHER CHAPTER OFFICERS:
For Southern California, Northern California, and Texas, please elect an Assembly Representative
or Member of the House of Representatives:
Name_________________________________________________________________________
Address__________________________________________________Apt #________________
City__________________________________________State__________Zip_______________
Phone (_________)_________________________Graduation Year_____________________
E-Mail________________________________________________________________________
Office Held: ____ Assembly Representative ____ House of Representatives
Name_________________________________________________________________________
Address__________________________________________________Apt #________________
City__________________________________________State__________Zip_______________
Phone (_________)_________________________Graduation Year_____________________
E-Mail________________________________________________________________________
Office Held____________________________
For Arizona, Pacific Northwest, Texas,
Northern and Southern California,
Please return to:
800 S Claremont St, Suite 202
San Mateo, CA 94402
For Mid-Atlantic, Midwest, Ohio River
Valley, Northeast, and Southeast,
Please return to:
1411 K St NW, Suite 200
Washington, DC 20005