UCHAPS Delegate Form

 

instructions

Identify two active delegates and one alternate delegate for community and government. These individuals will serve as the official voting representatives to UCHAPS through December 31, 2019.

1. Active Community Delegate and Steering Committee Rep *
1. Active Community Delegate and Steering Committee Rep
2. Active Community Delegate
2. Active Community Delegate
3. Alternate Community Delegate
3. Alternate Community Delegate
4. Active Government Delegate and Steering Committee Rep *
4. Active Government Delegate and Steering Committee Rep
5. Active Government Delegate
5. Active Government Delegate
6. Alternate Government Delegate
6. Alternate Government Delegate
Indicate name of person completing this form for the jurisdiction. *
Indicate name of person completing this form for the jurisdiction.
*