CLUB OFFICERS, BOARD OF DIRECTORS AND MEMBERS OF YOUR AFFILIATED SDA/UKC CLUB

Name of club:  ______ _________________________________________________

                 Names of club officers                              Names of Board of directors

President  _____________________________           _____________________________

VP            _____________________________           _____________________________

Treasurer  _____________________________           _____________________________

Secretary   _____________________________          _____________________________

                                                                                      _____________________________

                                                                                      _____________________________

LIST BELOW ALL CLUB MEMBERS, INCLUDING THE ABOVE NAMES; WITH ADDRESS, TELEPHONE AND EMAIL ADDRESS.  Please type or print all names.