APPLICATION FOR NEW CHAPTER (within a domain)

The following information needs to be sent to the ANC: Chapters, and your Regional Coordinator. Both contacts can be found on the Contacts page.

Proposed Chapter Name:

Domain Code:
Domain Name:
Region:

Interim Chapter Coordinator (CC):
Interim CC Camarilla Membership #:
Interim CC e-mail address:

Interim Assistant Chapter Coordinator (ACC): [Complete for each ACC.]
Interim ACC Camarilla Membership #:
Interim ACC e-mail address:

Proposed Chapter's physical mailing address: [For contact purposes.]

List each member's Name & Camarilla Membership #
[You should have at least 10 paid members.]

Theme or Goal of the Chapter:

Any Additional Comments: