EmailMeForm
USWT Celebrating Successes Year-End Recognition
The state membership vice president or district director should complete this form. Maintain a copy for your files. Final submissions must be completed no later than May 1.
Responses to the online form will be viewed by the USWT Membership Vice President, and your state contact. Fill in as much information as you know. Upon completion of the form, click Submit; you will receive a confirmation screen if your form has been successfully submitted. (rev 2017)
Your Email
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State
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Please select
Arizona
Illinois
Iowa
Massachusetts
Minnesota
Missouri
Nebraska
New Jersey
North Dakota
Oklahoma
Pennsylvania
South Dakota
Wisconsin
Cyprus
Other
Other State
If you are a member of a state organization not listed, please enter your state.
Name
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First
Last
Position
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Phone
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Address
Street Address
City
State / Province / Region
Postal / Zip Code
Date Submitted
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MM
/
DD
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YYYY
Membership Accomplishments
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Double-Up Chapter(s)
Triple-Up Chapter(s)
5-Member Recruiters
10-Member Recruiters
Other
Check all that apply for what the chapters in your district or state have accomplished
Double-Up Chapters
Chapter Name
Beginning Membership Base
Ending Membership Base
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Triple-Up Chapters
Chapter Name
Beginning Membership Base
Ending Membership Base
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
5-Member Recruiters
Recruiter Name
Recruiter Chapter
Recruiter 1
Recruiter 2
Recruiter 3
Recruiter 4
Recruiter 5
10-Member Recruiters
Recruiter Name
Recruiter Chapter
Recruiter 1
Recruiter 2
Recruiter 3
Recruiter 4
Recruiter 5
Other Explanation
*
If you chose "other" for the membership accomplishments, please explain
