Credentials of Delegate Form

Know All Persons By These Present That:

are the duly elected Delegates of the:

The aforementioned respresentatives are authorized to act on behalf of the [society] and its membership, as provided for by the Bylaws of the American Association for Respiratory Care.

The above Delegation has been elected by the Active Members of the Association within their respective Chartered Affiliate:
Yes No

Delegate Information

1st Delegate
Address:

City:
State:
Zip:
Work Phone:
Fax:
Email:
Term ends:
Oriented during term? Yes No

2nd Delegate
Address:

City:
State:
Zip:
Work Phone:
Fax:
Email:
Term ends:
Oriented during term? Yes No

3rd Delegate
Address:

City:
State:
Zip:
Work Phone:
Fax:
Email:
Term ends:
Oriented during term? Yes No

I, ,
attest these are the duly-elected delegates
representing the [society].

American Association for Respiratory Care House of Delegates

Credentials of Delegate Form

Delegate Information

1st Delegate

2nd Delegate

3rd Delegate