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* 1. Chapter Name:

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* 2. Local Chapter Advisor Name:

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* 3. Local Chapter Advisor Email:

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* 4. Which State Executive Council Member would you like to request to attend your meeting or event?

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* 5. Please provide the date and time of your event:

Date
Time

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* 7. How many members / people will be attending your event?

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* 8. Would you like the Executive Council Member to attend virtually or in-person?

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* 9. What will your expectations be for the State Executive Council member? For example, will you want them to present on a certain topic, give a speech, etc.

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* 10. Is your chapter willing or able to pay any expenses the Executive Council Member may incur related to fuel and/or meals?

T