2020 AHEPA D6 Convention Delegate Form
Kindly complete the District 6 form below to submit delegates and alternates for the virtual convention to be held on Saturday, June 27, 2020 at 1:00 pm.
If no information is available, please indicate N/A. Please provide an e-mail address for all delegates and alternates.
* Required
Email address
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Your email
Chapter Name and Number
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Your answer
Date meeting was held
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MM
/
DD
/
YYYY
Number of Attendees
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Your answer
Delegate 1 - Member #
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Your answer
Delegate 1 - Name
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Your answer
Delegate 1 - Address
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Your answer
Delegate 1 - Email address
Your answer
Delegate 2 - Member #
*
Your answer
Delegate 2 - Name
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Your answer
Delegate 2 - Address
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Your answer
Delegate 2 - Email address
Your answer
Delegate 3 - Member #
*
Your answer
Delegate 3 - Name
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Your answer
Delegate 3 - Address
*
Your answer
Delegate 3 - Email address
Your answer
Delegate 4 - Member #
*
Your answer
Delegate 4 - Name
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Your answer
Delegate 4 - Address
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Your answer
Delegate 4 - Email address
Your answer
Delegate 5 - Member #
*
Your answer
Delegate 5 - Name
*
Your answer
Delegate 5 - Address
*
Your answer
Delegate 5 - Email address
Your answer
Delegate 6 - Member #
*
Your answer
Delegate 6 - Name
*
Your answer
Delegate 6 - Address
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Your answer
Delegate 6 - Email address
Your answer
Alternate 1 - Member #
*
Your answer
Alternate 1 - Name
*
Your answer
Alternate 1 - Address
*
Your answer
Alternate 1 - Email address
Your answer
Alternate 2 - Member #
*
Your answer
Alternate 2 - Name
*
Your answer
Alternate 2 - Address
*
Your answer
Alternate 2 - Email address
Your answer
Alternate 3 - Member #
*
Your answer
Alternate 3 - Name
*
Your answer
Alternate 3 - Address
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Your answer
Alternate 3 - Email address
Your answer
Alternate 4 - Member #
*
Your answer
Alternate 4 - Name
*
Your answer
Alternate 4 - Address
*
Your answer
Alternate 4 - Email address
Your answer
Alternate 5 - Member #
*
Your answer
Alternate 5 - Name
*
Your answer
Alternate 5 - Address
*
Your answer
Alternate 5 - Email address
Your answer
Alternate 6 - Member #
*
Your answer
Alternate 6 - Name
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Your answer
Alternate 6 - Address
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Your answer
Alternate 6 - Email address
Your answer
Past District Governor, Past Supreme President, or District Lodge Officer
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Your answer
Please type your name below, which will serve as the electronic signature attesting to the information submitted on behalf of the President and Secretary
*
Your answer
After completing the above delegate registration form for the 2020 convention, kindly submit the fee of $25 per member, either by check payable to AHEPA Chapter #405, c/o Holy Trinity Greek Orthodox Church, 10 Mill Rd., New Rochelle, NY 10804 or at
https://ahepa-chapter-405.square.site
. The deadline to receive the delegate form and fees is Friday, June 12, 2020.
In order to vote at the district convention all delegates and alternates, must be in good standing, and paid through 2019 to the district and 2020 to national.
Any Chapters who have not yet paid their $7 per member district per capita, should immediately forward the amount payable to AHEPA District 6 c/o Brother Peter Ragoussis, 192-22 37th Ave., Flushing, NY 11358. Please contact District Secretary Chris Pappis with any questions at
secretary@ahepad6.com
.
A copy of your responses will be emailed to the address you provided.
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