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FORM C - NAEMSP Chapter Annual Report
Due Annually - July 1
Chapter Name
*
Period (current month/year)
Current Officers
President
Vice Pres/Pres Elect
Immediate Past President
Secretary
Treasurer
Members-At-Large/Other
Members-At-Large/Other
Members-At-Large/Other
Current Chapter Information
Number of Members
A listing members must also be submitted. Please upload your chapter membership listing.
Is this chapter incorporated?
Yes, this chapter is incorporated
No, this chapter is not incorporated
How much revenue did your chapter bring in over the course of the year? (Please see the latest chapter statement of activity provided).
If your chapter does not collect chapter dues, please enter 'N/A'.
Did your chapter receive any funding outside of chapter dues?
Yes
No
If your chapter received funding outside of chapter dues, how much funding was awarded?
Chapter Goals/Initiatives:
Chapter Meetings During the Year. Please provide dates.
Chapter Accomplishments:
File Upload
Attach any educational program material, media coverage, etc.
Submitted by
Date Submitted
MM
/
DD
/
YYYY
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