Chapter Credentials Form Chapter InformationSelect your chapter form the list below then scroll to the bottom and click nextSCROLL to the bottom of the page to click the NEXT button.Chapter Name *Agnes Hill ChapterAlexander DoniphanAnn HaynesAnne HelmArmstrongArrow RockBlue SpringsBowling GreenCaptain Henry WhitenerCarl NeimanCaroline Close StuartCarrolltonChalk BluffCharity Stille LangstaffClark CountyClay County PatriotsColumbianContinental CongressCornelia GreeneCrowley's RidgeDorcas RichardsonElizabeth BentonElizabeth CareyElizabeth HarrisonEnter the number of members recorded on 12/1/2024This is the membership count on 12/1/2024Membership on 12/1/2024 *This number is the number of members on record on 12/1/2024Name of Chapter Regent *Is the Chapter Regent attending State Conference 2025? *YesNoIs the Chapter Vice Regent attending so as to represent the regent as a voting delegate?YesNoMark "Yes" ONLY if the vice regent will attend state conference in place of /AND will REPRESENT the (NON-ATTENDING) chapter regent as a voting delegate. a double check: Both The regent and vice regent WILL NOT be attending state conference. *YesThis is not usual. Mark Yes if NEITHER the regent or vice regent can attend.Number of Delegates *Elected DelegatesListed in order electedDelegate SectionFull Name *National Number *Enter office or position in the chapter *SignaturesE-signature of Chapter Recording Secretary *Date *Enter today's dateVerification of Chapter Recording Secretary *As Chapter Recording Secretary, I certify that the Delegates and/or Alternates to the Missouri State Conference listed in this form were dulyelected at a regular chapter meeting held on: Date *Chapter meeting date when delegates/alternates were elected.E-signature of Chapter Treasurer *Date *Today's DateVerification of Chapter Treasurer *As Chapter Treasurer, I certify the Dues for each of the (above) named (entered into the form) and duly elected delegates and alternates were postmarked with a cancellation date no later than December 1, 2024. This is my e-signature. Signature of Chapter Regent *Date *YearSelect Year212521242123212221212120211921182117211621152114211321122111211021092108210721062105210421032102210121002099209820972096209520942093209220912090208920882087208620852084208320822081208020792078207720762075207420732072207120702069206820672066206520642063206220612060205920582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031Enter today's dateVerification of Chapter Regent *06/12/2025 5:21:59 am, GMT+0000 As Chapter Regent, I certify that all of the above is correct in accordance with the Bylaws and Standing Rules of the Society. This is my e-signature.Send MessageSave as Draft
