Detachment Delegate Form. Only To be Completed By Your Detachment.

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Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Registrant Name

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Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Registrant Name

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Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Registrant Name

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Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Registrant Name

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Please check ALL the appropriate boxes

Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Registrant Name

Please Include Contact Information

Please check ALL the appropriate boxes

Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Registrant Name

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Please check ALL the appropriate boxes

Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Registrant Name

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Please check ALL the appropriate boxes

Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Registrant Name

Please Include Contact Information

Please check ALL the appropriate boxes

Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Registrant Name

Please Include Contact Information

Please check ALL the appropriate boxes

Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Registrant Name

Please Include Contact Information

Please check ALL the appropriate boxes

Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Registrant Name

Please Include Contact Information

Please check ALL the appropriate boxes

Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Registrant Name

Please Include Contact Information

Please check ALL the appropriate boxes

Registrant is Attending Registrant is Not Attending Registrant is A Delegate Registrant is an Alternate Registrant is a Guest Registrant's First Time?

Attestation:*

I certify that the following members listed on this delegate form are paid members of my Detachment and will represent this Detachment at the Department Convention 2024. I further certify that these members are in good standing with the Department. I understand that members not in good standing can not be registered.

Attestation Signature:*

Commandant / Paymaster

My Detachment is in good standing with Department.*

Yes No

Detachments not in good standing will not be registered.

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