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Chapter & Activity Information  
     
 
Chapter Name:
Activity:
Begin Date/Time:
End Date/Time:
Location:
Meeting Site:
Site Telephone:
Purpose of Visit:
Please fully describe the major duties, expectations, and commitments of the officer for this event.
   
 
Advisor & Contact Information  
     
 
Contact Person:
Work Phone:
Cell Phone:
Email Address:
Address:
City:
State:
Zip Code:
Advisor Name:
Advisor Work Phone:
Advisor Cell Phone:
   
Requested Officer Name:   (Please note that the officer you request may not be available)
   
 
 

   
   
 
   
 
 
     
 
   
 
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