DELEGATE CERTIFICATION ---------------------- 71st Western Region Convention
THE DEADLINE FOR DELEGATE CERTIFICATION DETAILS IS FRIDAY, MARCH 8TH, 2019

Before you fill out this form, please read the following Instructions for use of this online delegate certification form for the 71st Western Region Convention of Alpha Phi Alpha Fraternity, Inc.:

1. The chapter president or his designee should complete this form.

2. Whomever completes this form must supply their email address AND the chapter president's email address for verification purposes.

3. Your chapter must be in good standing with the Corporate HQ & the Western Region to register your delegates.

4. All delegates must be in good standing with the Corporate HQ & their chapter to be registered as a delegate.

5. All delegates must be registered for the 71st Western Region Convention of Alpha Phi Alpha Fraternity, Inc. to serve as a delegate.

6. List no more than the maximum number of your chapter's delegate strength. Additions beyond a chapter's delegate strength will not be considered. (see below if you are unsure of your chapter's delegate strength).

7. Delegate signatures will be obtained on-site at the time of convention check-in

*if there are any further questions on the use of this form or delegate certification, please email delegates@alphawest.org

Email address *
What is the email address of the chapter president? *
Your answer
Select Your District *
What is Your Chapter's Name? *
What is Your Chapter's Seat? (Alumni Chapters should indicate a city, Collegiate Chapters should indicate a college campus) *
Your answer
Delegate 1 - Full Name & Alpha Account # : (First MI Last, Alpha Account #) *
Your answer
Delegate 2 - Full Name & Alpha Account # : (First MI Last, Alpha Account #)
Your answer
Delegate 3 - Full Name & Alpha Account # : (First MI Last, Alpha Account #)
Your answer
Delegate 4 - Full Name & Alpha Account # : (First MI Last, Alpha Account #)
Your answer
Delegate 5 - Full Name & Alpha Account # : (First MI Last, Alpha Account #)
Your answer
Delegate 6 - Full Name & Alpha Account # : (First MI Last, Alpha Account #)
Your answer
WR COMPLIANCE REPORT WITH DELEGATE COUNTS 2.17.19
A copy of your responses will be emailed to the address you provided.
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