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Affiliate Report Form
Affiliate Name:
Reporting Year (Year Activities Occured)
2010
Current Chairman Name:
Current Chairman's Mailing Address
Current Chairman's Email
Current Chairman's Work Phone Number
Current Chairman's Home Phone Number
Additional Contact Name
Additional Contact's Mailing Address
Additional Contact's Email
Additional Contact's Work Phone Number
Additional Contact's Home Phone Number
Current # of Affiliate Members
# of Current Affiliate Members who are also NACNS members
Our affiliate would be willing to mentor other affiliates:
Yes
No Thanks
Please describe affliate activities and intiatives that you have been engage in this reporting year. Please describe events, projects, activities and outcomes.
Significant issues concerns to the affliate (please include suggestions that NACNS may be able to provide):
Have your bylaws been amended?
No
Yes
Attach Bylaws or Operation Guidelins
If Your Affiliate Has a Website, Please list the URL
Attach Roster
Submit