EmailMe Form - NBA Division Certification Form

Division Certification Form
(See NBA Constitution, Article VIII, Section 3.D and NBA By-Laws Chapter V, Section 3).
This is to certify that the following division met on the following day for its annual meeting and the following person, who is a regular member of the Association, was elected chairperson and will present the Division on the NBA Board of Governors.
Section/Division Name
Name/Newly-Elected Chairperson *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Email *
Office Number *
### - ### - ####
Home Number *
### - ### - ####
Name *
First Last
Section/Division Office *
Date *
MM / DD / YYYY
Name *
First Last
Section/Division Office *
Date *
MM / DD / YYYY
Is your Division's account managed by a seperate bank account? *
Yes
No
If yes, please provide the name(s) of the Bank, its location , Account number and balance. If you do not have a separate account, please list "NOT APPLICABLE" or "N/A" *
1 / 2