ALDA Chapter Renewal Form

ALDA CHAPTER CHARTER RENEWAL FORM

This form needs to be completed and submitted in order to request that ALDA, Inc. renew the petitioners' ALDA Chapter Charter.

Given our desire to be of further service to people with hearing loss, and our desire to continue to promote ALDA, Inc., we hereby request ALDA, Inc. to renew our Chapter Charter for the coming year.
If our Chapter Charter is renewed, we pledge to continue to pursue one or more of the objectives of ALDA, Inc. during the year ahead.
We attest that we are over 18 years old; that we are members in good standing of ALDA, Inc, with our dues paid up-to-date; and that we will serve as the designated officers of our Chapter during the coming year.
Name of Chapter:*
Date*
Please provide contact information for the petitioner who will serve as PRESIDENT of our ALDA Chapter during the coming year.
Name*
First Last
Address*
Street Address City State ZIP Code
Phone
Email*
Please provide contact information for the person who will serve as VICE PRESIDENT of your ALDA Chapter during the coming year.
Name*
First Last
Address*
Street Address City State ZIP Code
Phone
Email
Please provide contact information for the person who will serve as SECRETARY of the requested ALDA Chapter.
Name*
First Last
Address*
Street Address City State ZIP Code
Phone
Email*
Please provide contact information for the person who will serve as TREASURER of your ALDA Chapter during the coming year.
Name*
First Last
Address*
Street Address City State ZIP Code
Phone
Email*
Please provide the following additional information concerning your Chapter:
Number of members in your Chapter:*
Does your Chapter have a newsletter?*
- Yes
- No
Does your Chapter have a brochure?*
- Yes
- No
Does your Chapter have a website?*
- Yes
- No
If your Chapter has a website, what is the website address (URL)?
How often does your Chapter meet?*
- Monthly
- Bimonthly
- Occasionally
Brief Summary of Past Group Activities:*