This form will be used in place of CHEA Form 1004. Complete the information and click “send” – the content will be immediately emailed to our Executive Assistant, Charisce.

    Your Name (required)

    Your Email (required)

    District Chairman Recommendations

    Select the District:

    Accounting Consultants Chairman

    Name:

    Spouse:

    Lodge:
    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Americanism

    Name:

    Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    BLT Legacy Giving Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Bowling Chairman (Optional)

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Business Practices Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
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    Cell:
    Fax:
    Email:

    CLMS Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
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    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Drug Awareness Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Financial Reporting System Coordinators

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Government Relations Chairman

    Name: Spouse:

    Lodge:

    Address:
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    Zip:
    Residential:
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    Cell:
    Fax:
    Email:

    Grand Lodge/Convention Housing Coordinator

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Hoop Shoot Chairman

    Name: Spouse:

    Lodge:

    Address:
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    State:
    Zip:
    Residential:
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    Cell:
    Fax:
    Email:

    Insurance & Safety Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
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    Cell:
    Fax:
    Email:

    Lodge Activities Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Membership/Lapsation Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    National Foundation Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
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    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    National Foundation Grants Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
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    Cell:
    Fax:
    Email:

    National Veterans Service

    Name: Spouse:

    Lodge:

    Address:
    City:
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    Zip:
    Residential:
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    Cell:
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    Email:

    Officers Training Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
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    Cell:
    Fax:
    Email:

    Piggy Bank Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
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    Cell:
    Fax:
    Email:

    Public Relations Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
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    Cell:
    Fax:
    Email:

    Ritual Contest Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Ritual Contest Member #1

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Ritual Contest Member #2

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Ritual Training Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Scholarship Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:

    Scouting Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:


    Youth/Soccer Activities Chairman

    Name: Spouse:

    Lodge:

    Address:
    City:
    State:
    Zip:
    Residential:
    Business:
    Cell:
    Fax:
    Email:



    Comments

    CHEA District Chairman Recommendations — 9 Comments

    1. Please send me back a copy of the above committee chairman so I can forward it on to my district directory chairman.

      Thank you,

      Steve

    2. Hi Charisce, please send me a list that can be saved or printed. I want to send it to my District Directory Chairman.
      Thanks

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