ECV Chapter Statistical Reporting Submission

2024 Annual Chapter Statistical Reporting
Indicates Required Field*

Chapter *2024 Officer Installation Date *

Official Chapter/Outpost Website:
Website:

2023 X-Humbug Information:
First Name: * Nickname (if any): Last Name: *

2024 Noble Grand Humbug Information:
First Name: * Nickname (if any): Last Name: *

Address: * City, State: * Zip Code: *

Home Phone: * Cell Phone: E-mail Address: *

2024 Grand Nobel Recorder Information:
First Name: * Nickname (if any): Last Name: *

Address: * City, State: * Zip Code: *

Home Phone: * Cell Phone: E-mail Address: *

2024 Gold Dust Receiver Information:
First Name: * Nickname (if any): Last Name: *

Address: * City, State: * Zip Code: *

Home Phone: Cell Phone: E-mail Address: *

Person Completing this Submission:

First Name * Last Name *

Contact Phone * E-mail Address *

* By checking this box I certifiy I am a Legal Representative of this Chapter.

You must certify you are a legal representative of this Chapter to continue.