EmailMe Form - MNWT Intent to Reactivate

MNWT Intent to Reactivate

This form is used to notify the state that your chapter wishes to be reactivated.

NOTE: this form requires three (3) signatures: Reactivation Team Chair, as well as the Chapter President and State Delegate or two (2) other Reactivation Team Members. Be sure to have all signatory representatives present when completing this form. Signatures can be done by your mouse, or your finger on a writable screen.

Responses to the online form will be viewed by your district director, the state chapter management vice president, and the state president. 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 2015)

Submission Date *
MM / DD / YYYY
Your Email *
District *
Chapter *
Reactivate Chapter Name *
Enter the name of the chapter that your chapter intends to reactivate
Number of Miles from Community
Approval Date *
MM / DD / YYYY
Enter the date approved by chapter or Extension team
Is your chapter willing to make a commitment to assist and support the reactivated chapter for a minimum of two (2) years? *
Yes
No
Have you been approached by anyone to do this? *
Yes
No
By whom have you been approched? *
Since you said you were approched by someone to reactivate this chapter, please list who and explain
Have you discussed this with your district director? *
Yes
No
If not, do so immediately
Have you set meeting date(s)? *
Yes
No
If not, do so immediately
Meeting Date(s) *
Enter dates or explain your approach to meeting potential members
Reactivation Reason *
What is your reason for wanting to do this reactivation?
Reactivation Team Chair Signature *
Clear
Reactivation Chair Name *
First Last
Enter the name of Reactivation Team Chair
Reactivation Chair Email *
Reactivation Chair Address *

Street Address City State / Province / Region Postal / Zip Code
Reactivation Chair Phone *
### - ### - ####
Chapter President or Another Reactivation Team Member Signature *
Clear
Chapter President or Another Reactivation Team Member Name *
First Last
Enter the name of President or another Reactivation Team Member
Chapter President or Another Reactivation Team Member Email *
Chapter President or Another Reactivation Team Member Address *

Street Address City State / Province / Region Postal / Zip Code
Chapter President or Another Reactivation Team Member Phone *
### - ### - ####
Chapter State Delegate or Another Reactivation Team Member Signature *
Clear
Chapter State Delegate or Another Reactivation Team Member Name *
First Last
Enter the name of State Delegate or another Reactivation Team Member
Chapter State Delegate or Another Reactivation Team Member Email *
Chapter State Delegate or Another Reactivation Team Member Address *

Street Address City State / Province / Region Postal / Zip Code
Chapter State Delegate or Another Reactivation Team Member Phone *
### - ### - ####
Other Pertinent Information
Enter any other pertinent information