LOCAL ASSOCIATION OFFICERS REPORT

Electronic Form

Please complete the names and addresses of Association Manager, President, and Publicity Chairman as this information is our communication line. These local representatives submitted on this report annually receive a complimentary subscription to the IN INDIANA publication.

Comments can be added at the bottom of the page just above where you submit your form to the IS USBC WBA Association Manager.

Association Name
Local Association Number

Are you merged or non-merged association?
Merged Non-Merged

This Officers Report is being submitted by:

ASSOCIATION MANAGER:

Name: Area Code/Home Phone:

Address: Area Code/Office Phone:

City/State/Zip:

E-Mail:

This Officers Report is being submitted by:
ASSOCIATION MANAGER:
Name:		Area Code/Home Phone:
Address:		Area Code/Office Phone:
City/State/Zip:
E-Mail:

PRESIDENT:
Name:		Area Code/Home Phone:
Address:		Area Code/Office Phone:
City/State/Zip:
E-Mail:

PUBLICITY CHAIRMAN:
Name:		Area Code/Home Phone:
Address:		Area Code/Office Phone:
City/State/Zip:
E-Mail:

OTHER COMMENTS: