PLEASE SUBMIT THIS FORM BY October 15th Chapter Roster Form Update your chapter roster by providing the Girlfriends' name, email and phone number. CHAPTER NAMEChapter SelectionAlbanyAtlantaBaltimoreBirminghamBostonBrooklynBuffaloCaliforniaCharlotteChicagoCincinnatiClevelandColumbiaColumbusDallasDetroitDurhamFairfield CountyGolden StateGreenvilleHoustonLas VegasLoudoun CountyLouisvilleMemphisMiamiMilwaukeeMinneapolis/St. PaulNashvilleNew HavenNew JerseyNew OrleansNew YorkNewport NewsNorfolkOrlandoPhiladelphiaPittsburghPotomacRichmondRoanokeSan DiegoSeattleSpringfieldSt. LouisToledoTrentonWashingtonCHAPTER PRESIDENT INFORMATIONPresident's Name* First Last President's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code President’s Phone Number*President’s Email Address*CHAPTER GIRL FRIENDS FUND LIAISON INFORMATIONGirl Friends Fund Liaison’s Name* First Last Girl Friends Fund Liaison’s Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Girl Friends Fund Liaison’s Phone Number*Girl Friends Fund Liaison’s Email* CHAPTER TREASURER INFORMATIONChapter Treasurer's Name* First Last Chapter Treasurer's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Chapter Treasurer's Phone Number*Chapter Treasurer's Email* CHAPTER SCHOLARSHIP COMMITTEE CHAIR INFORMATIONChapter Scholarship Committee Chair's Name First Last Chapter Scholarship Committee Chair's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Chapter Scholarship Committee Chair's Phone NumberChapter Scholarship Committee Chair's Email CHAPTER PIONEER SCHOLARSHIP CAMPAIGN REPRESENTATIVE INFORMATIONPioneer Scholarship Campaign Representative’s Name First Last Pioneer Scholarship Campaign Representative’s Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Pioneer Scholarship Campaign Representative’s Phone NumberPioneer Scholarship Campaign Representative’s Email Δ