School or Organization Name

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1. School or Organization Name

Chapter Name

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2. Chapter Name

Advisor's Name

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3. Advisor's Name

Phone Number

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4. Phone Number

Email Address

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5. Email Address

Shipping Address (No PO Boxes)

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6. Shipping Address (No PO Boxes)

County

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7. County

Total Number of Chapter Members

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8. Total Number of Chapter Members

Total Number of African American Chapter Members

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9. Total Number of African American Chapter Members

Total Number of Caucasian Chapter Members

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10. Total Number of Caucasian Chapter Members

Total Number of Team Members of Other Races/Ethnicities

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11. Total Number of Team Members of Other Races/Ethnicities

Total Number of Males

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12. Total Number of Males

Total Number of Females

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13. Total Number of Females

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