2025 Chapter and Affiliate Officers Information Form

Chapter or Affiliate Name

President’s Name

Address

City

State

Zip code

Home Phone

Cell or Work Phone

Please indicate which phone number is to be used for the CCB web site.

Please indicate which email address is to be used for the CCB web site.

1st Vice-President’s Name

Address

City

State

Zip code

Home Phone

Cell or Work Phone

Please indicate which phone number is to be used for the CCB web site.

Please indicate which email address is to be used for the CCB web site.

2nd Vice-President’s Name

Address

City

State

Zip code

Home Phone

Cell or Work Phone

Secretary’s Name

Address

City

State

Zip code

Home Phone

Cell or Work Phone

Treasurer’s Name

Address

City

State

Zip code

Home Phone

Cell or Work Phone

If CCB has a check payable to the chapter or affiliate, where should it be mailed? Name of recipient

Address

City

State

Zip code

Designees for the Presidents’ Email Listserv. Name of first designee

Email Address

Name of second designee

Email Address

Membership Contact (this person’s email address will also be subscribed to the Membership listserv) Membership Contact Name

Email Address

CCB Listserv Name

Name of the CCB Listserv Liaison

Email Address for the CCB Listserv Liaison

Chapter/Affiliate Meeting Location.

Meeting Time

Meeting Day of the week each month

Address of meeting location

City

State

Zip code

Phone number of meeting location

2025 Chapter and Affiliate Officers Information Form

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