Instructions: This form should be completed by each chapter, colony, and alumni club to verify the election or appointment of the delegate and alternate delegate. This form must be submitted to the Executive Office by June 30, 2012 . No delegate or alternate delegate may be officially recognized at the Convocation unless a Credentials Form has been duly signed by the officers of the chapter, colony, or alumni club and filed in advance of the Convocation. Failure to submit a Credentials form will be treated as an absence which may result in a fine being levied against the chapter or colony in question.
All fields must be completely and accurately filled in to be processed.
Delegate Information
(This form is to certify the following brother(s) has/have been selected as the official delegate and alternate delegate to the Convocation for said chapter, colony, or alumni club, date and place of which is given.)
Chapter/Colony/Alumni Club: (*)
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Delegate Name: (*)
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Graduation Year: (*)
---- 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929
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Current Office/Position: (*)
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Alternate Delegate Name: (*)
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Alternate Graduate Year: (*)
---- 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929
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Alt. Current Office/Position: (*)
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Selection Criteria
(select one)
The above delegate and alternate were elected at a meeting The above delegate and alternate were appointed as provided in the local bylaws
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If elected , date:
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If appointed , appointed by:
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If appointed , date:
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Authorized Officer Consent
Sage/President Name: (*)
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Phone XXX-XXX-XXXX: (*)
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Email: (*)
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Fourth Counselor/Secretary Name: (*)
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Phone XXX-XXX-XXXX: (*)
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Email: (*)
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Note To Undergraduate Chapters and Colonies
Each Chapter in good standing shall be entitled to representation at the Convocation by one delegate and one alternate, exclusive of any Grand Chapter Officer or Past Grand Officer. These representatives must be undergraduate members of the Chapter; and elected or appointed as prescribed in the local chapter bylaws. Only the one chapter or colony delegate will receive lodging benefits associated with Convocation. The Alternate Chapter Delegate and Alumni Club Delegates Are Responsible For Their Own Expenses!
Registration Form and Fee Must Also Be Submitted.
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