EmailMe Form - FORM C - NAEMSP Chapter Annual Report

Chapter Name *

Period (current month/year)

Current Officers

President

Term Begin Date

MM / DD / YYYY

Term End Date

MM / DD / YYYY

Vice Pres/Pres Elect

Term Begin Date

MM / DD / YYYY

Term End Date

MM / DD / YYYY

Immediate Past President

Term Begin Date

MM / DD / YYYY

Term End Date

MM / DD / YYYY

Secretary

Term Begin Date

MM / DD / YYYY

Term End Date

MM / DD / YYYY

Treasurer

Term Begin Date

MM / DD / YYYY

Term End Date

MM / DD / YYYY

Members-At-Large/Other

Term Begin Date

MM / DD / YYYY

Term End Date

MM / DD / YYYY

Members-At-Large/Other

Term Begin Date

MM / DD / YYYY

Term End Date

MM / DD / YYYY

Members-At-Large/Other

Term Begin Date

MM / DD / YYYY

Term End Date

MM / DD / YYYY

Members-At-Large/Other

Term Begin Date

MM / DD / YYYY

Term End Date

MM / DD / YYYY

Members-At-Large/Other

Term Begin Date

MM / DD / YYYY

Term End Date

MM / DD / YYYY

Professional Member-At-Large/Other

Term Begin Date

MM / DD / YYYY

Term End Date

MM / DD / YYYY

Executive Director

Term Begin Date

MM / DD / YYYY

Term End Date

MM / DD / YYYY

Current Chapter Information

Number of Members

A listing members must also be submitted. Please upload your chapter membership listing.

Is this chapter incorporated?

Yes, this chapter is incorporated

No, this chapter is not incorporated

How much revenue did your chapter bring in over the course of the year? (Please see the latest chapter statement of activity provided).

If your chapter does not collect chapter dues, please enter 'N/A'.

Did your chapter receive any funding outside of chapter dues?

Yes

No

If your chapter received funding outside of chapter dues, how much funding was awarded?

Chapter Goals/Initiatives:

Chapter Meetings During the Year. Please provide dates.

Chapter Accomplishments:

File Upload
Attach any educational program material, media coverage, etc.

Submitted by

Date Submitted

MM / DD / YYYY