CHAPTER
DISTRICT / AREA
CERTIFICATION OF SERVICE RECORD OF AMERICAN LEGION RIDERS CHAPTER OFFICERS
DEPARTMENT
CHAPTER YEAR
2015-2016
OF
CALIFORNIA
CHAPTER SECRETARY: Upon election and/or appointment of Chapter officers for Chapter Year
designated, fill in this form and return by mail. Complete all items. Show "None" where that applies.
POINT OF CONTACT NAME AND PHONE #
POINT OF CONTACT EMAIL
CHAPTER
DUES
INCORPORATED
___YES____NO
CHAPTER MAILING ADDRESS:
ADDRESS OF REGULAR MEETINGS
OFFICERS
MEMBERSHIP I.D.
NAME
CHAPTER WEBSITE ADDRESS
ELECTION DATE
TELEPHONE NO. (Show area codes)
INSTALLATION DATE
MEET DATE & TIME
LEGION
AUXILIARY
SQUADRON
President Name
and Email Address
Vice President
Secretary
Treasurer
Chaplain
Sgt. At Arms
Historian
Road Captain
I hereby certify that each of the above officers is eligible for membership in The American Legion Riders and has the consequent
right to service in such capacity in accordance with Article V, Section 3, and Section Department By-laws.
(Chapter Secretary)
ONE COPY TO: Department Secretary
(Chapter President)
ONE COPY TO: Area Vice President
ONE COPY: Chapter Files