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                                    Just complete this form and click on Submit when you're ready to send. *

Name:

Email:

Phone:

List me as:
(send one form for each designation)

Certified Clerk
Uncertified Clerk
Ring Clerk assist
Licensed Master Clerk
Unlicensed Master Clerk
Master Clerk assist
Entry Clerk
Steward

 

Region:

Region 1
Region 2
Region 3
Region 4
Region 5
Region 6
Region 7

 

Your location (closest metropolitan area, city & state)

 

How would you like clubs to contact you?

 

Comments:

 



*Note – In order to protect email address and phone numbers from "SPAM bots", I have created a .jpg file for each email address ("bots" don’t read image files) and I have added "REMOVE" to the end email address link.

When emailing a Clerk or Steward you can either; open a new email and copy and paste the email address from the email image or click on the email address image and remove the "REMOVE" at the end of the address.

Phone number have spaces inserted around the dash between the area code and phone number.