The attached Delegate Certification Form is to be used for the 85th Annual Region Convention. PLEASE fill out the form completely, and return it to me via email, or snail mail — on or before Friday, March 31, 2017.

  • My email address is:
  • Snail Mail Address is: 96 Oxford Place , Hillsborough , NJ 08844

In addition, YOU MUST bring a copy of your Delegate Certification Form with you to Virginia– with your “raised” Chapter Seal on it.

If you have questions or clarification is needed, feel free to reach out to me by phone at: 267-767-7032. Thanks!

Doyal H. Siddell, Chairman
Eastern Region Rules & Credentials Committee

Click on the image or button below to download the delegate certification form.

Delegate Certification Form

Download Form