Local AECG Membership Local AECG Association Membership Committee application form Local AECG Region Date MM DD YYYY Select an Option: AGM Re-establishment Newly Establish President Local President * Delegate to Region Yes No Proxy Address Address 1 Address 2 City State/Province Zip/Postal Code Country Working with Children's Check (WWCC) Phone (###) ### #### Email * Vice President Local Vice President Delegate to Region Option 1 Option 2 Proxy Address Address 1 Address 2 City State/Province Zip/Postal Code Country Working with Children's Check (WWCC) Phone (###) ### #### Email Secretary Local Secretary Delegate to Region Yes No Proxy Address Address 1 Address 2 City State/Province Zip/Postal Code Country Working with Children's Check (WWCC) Phone (###) ### #### Email Treasurer Local Treasurer Delegate to Region Yes No Proxy Address Address 1 Address 2 City State/Province Zip/Postal Code Country Working with Children's Check (WWCC) Phone (###) ### #### Email Thank you!
