Society of Professional Journalists
Improving and protecting journalism since 1909

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Delegate Verification Form

Chapter delegates will need to be present at the following business sessions:

— Saturday, August 24, 2-3 p.m.
— Monday, August 26, 4-5:30 p.m.

For your information, regional meetings will be held on Saturday, August 24 from 1-2 p.m. Check the program book for locations.


Chapter information and contacts

Chapter Name:
Chapter President:
Number of Delegate Votes Authorized:
Is your chapter is challenging the authorized vote count?
Yes    No
Name of Person Submitting Form:
E-mail of Person Submitting Form:

Delegates Information

Important: Please be certain your delegates and their number of votes match the total votes authorized for your chapter.

Delegate No. 1

Name:
Membership Number:
No. of Votes:

Delegate No. 2

Name:
Membership Number:
No. of Votes:

Delegate No. 3

Name:
Membership Number:
No. of Votes:

Delegate No. 4

Name:
Membership Number:
No. of Votes:

Delegate No. 5

Name:
Membership Number:
No. of Votes:

Delegate No. 6

Name:
Membership Number:
No. of Votes:

Alternate Delegates Information

Alternate No. 1

Name:
Membership Number:
No. of Votes:

Alternate No. 2

Name:
Membership Number:
No. of Votes:

Alternate No. 3

Name:
Membership Number:
No. of Votes:

Alternate No. 4

Name:
Membership Number:
No. of Votes:

Reminder: Please be certain your delegates and their number of votes match the total votes authorized for your chapter.

Copyright © 1996-2014 Society of Professional Journalists. All Rights Reserved. Legal

Society of Professional Journalists
Eugene S. Pulliam National Journalism Center
3909 N. Meridian St.
Indianapolis, IN 46208
317/927-8000 | Fax: 317/920-4789

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