Affiliation Request Form

Affiliation Request Form
Fields marked with an * are required
Thank you for your interest in starting a federation.
Please fill out the form below and we will contact you as soon as possible!
Name*

First NameLast Name
Name of Organization *
As registered
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
List of Executive Board Officials*
Please list your executive board by title and the name of the person holding the title, including yourself. If your executive board is incomplete, please list only those in place at this time, including yourself.
Questions, concerns, or comments? List them here:
Should be Empty: