[printable version]
APPLICATION FOR US DOMAIN STATUS
The following information needs to be sent to the ANC: Chapters, RC, and RST of your region. These contacts are available at the USNC Contacts page.
The regional officers may have delegated their duty to an Assistant.
Proposed Domain Name:
Region:
Includes Chapters:
(list any chapters that make up the proposed domain; include whether they will be folded into the domain – not exist after the domain is formed; include chapter code and chapter name)
Proposed DC Name:
Proposed DC Cam #:
Proposed DC Email address:
Proposed ADC:
Proposed ADC Cam #:
Proposed ADC Email address:
(repeat as necessary)
Proposed Domain's physical mailing address (for contact purposes):
Proposed Domain's borders:
(Examples include "Tacoma city limits," or "Pierce County borders." If your proposed domain is adjacent to other Camarilla chapters or domains, please be more detailed.)
List each member's Name & Cam #
(15 paid members if within 30 miles of the next nearest Domain; 10 paid members
if more than that; this requirement can be waived with favorable RC recommendation)
Describe a charity event held in the last 6 months:
Describe a social event held in the last 6 months:
Comments:
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