*ATHA CHAPTER OFFICER REPORT
Date Submitted:
 
Name of Chapter:
 
Chapter Number:
  Region:   State:  
Newly Elected Officers:(ATHA bylaws require all chapter officers to be ATHA members in good standing)
President:
   Membership Renewal Date:  
Address:
City:
   State:   Zip:  
Phone:
   Email:  
Vice President:
   Membership Renewal Date:  
Address:
City:
   State:   Zip:  
Phone:
   Email:  
Treasurer:
   Membership Renewal Date:  
Address:
City:
   State:   Zip:  
Phone:
   Email:  
Secretary:
   Membership Renewal Date:  
Address:
City:
   State:   Zip:  
Phone:
   Email:  
Other Officer:
  Membership Renewal Date:  
Address:
City:
   State:   Zip:  
Phone:
   Email:  
Term of Office:   Election Month & Year:  
Please Return One Set to:

Diana O’Brien, Regional Coordinator
PO Box 310, Shelburne, MA  01370-0310
And One SetTo:
Regional Representative
* Please submit when an election is held
Updated June 7, 2009