Affiliate Dues/Profile

Today's Date*

Do you only need to pay your Affiliate Dues?*

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No

Name of Affiliate*

Affiliate Name

Affiliate Profile

Mailing Address*

Street Address City State ZIP Code

President*

Term Expires*

Work Phone*

Home Phone

Fax

Email Address*

Please Check All Your Officers*

President Elec/Vice
Recording Secretary
Treasurer
Financial Secretary
Corresponding Secretary
Parliamentarian
Historian
Chaplain

Officers (President)

Pres Elec/Vice Name

Pres Elec/Vice Email

Pres Elec/Vice Phone

Officers (Recording Secretary)

Rec Name*

Rec Email*

Rec Phone*

Officers (Treasurer)

Treasurer Name*

Treasurer Email*

Treasurer Phone*

Officers (Financial Secretary)

Fin Secretary Name*

Fin Secretary Email*

Fin Secretary Phone*

Officers (Corresponding Secretary)

Corr Secretary Name*

Corr Secretary Email*

Corr Secretary Phone*

Officers (Parliamentarian)

Parliamentarian Name*

Parliamentarian Email*

Parliamentarian Phone*

Officers (Historian)

Historian Name*

Historian Email*

Historian Phone*

Officers (Chaplain)

Chaplain Name*

Chaplain Email*

Chaplain Phone*

Affiliate Information

Number of Local Members

Date of Charter

Number of TABSE members*

Number of NABSE Members*

Number of TABSE Life members*

Affiliate Mission*

Major Projects*

Affiliate Fees

Enter Payment Amount*

Online Processing Fee*

Price: $0.00

Total Due Today

$0.00