DELEGATE CERTIFICATION FORM
CHAPTER: KEY # REGIONAL/NATIONAL OFFICE CERTIFICATION
REGION: DISTRICT: SEAT: ACTIVE MEMBERS: STATUS: DELEGATES: See AlphaNet
Instructions:
1. Please fill in the names and account numbers for the Brothers representing your Chapter as delegates at the 105th General Convention in Chicago, Illinois
2. Members listed must be registered for the convention before they can be pre-certified.
3. The chapter must be in good standing in order to register delegates for the convention. If your chapter is listed as not in “good standing” please, contact the Corporate Headquarters immediately.
4. Please log-in to AlphaNet to locate chapter delegate strength.
5. This form must be returned by ________June 3, 2011
6. Please Note: This form should not be used to register individuals for the convention. All convention registrants must use the official convention registration form in order to register for the convention. This form should only be used to submit chapter delegates.