2012-2013 ICA, Division and Chapter New Officer Form


Please use the following form to let ICA know who will be the key officers for your Division or Chapter for the next Governance year.

If you don't have the position called for, then just skip that field.

All Divisions or Chapters should list the incoming President. Please scroll down to the form and complete the items that apply to your group.

 

 


First Name *

Last Name *

Email *

Division or Chapter Name:
2012-2013 President: *
President Phone number: *
email address:
President: Street Address
President: City
President: State
President: Zip
2012-2013 President Elect:
email address:
2012-2013 President Elect-Elect:
email address:
2012-2013 Past President:
email address:
2012-2013 Vice President (if applicable)
email address:
2012-1013 Treasurer:
email address:
Treasurer: Street Address
Treasurer: City
Treasurer: State
Treasurer: Zip
2012-2013 Secretary:
email address:




Phone: 1.877.284.1521 • Fax: 815-787-8787 • ICAexecdir@aol.com • PO Box 367,  DeKalb, IL 60115