Regional Group Officer Report Form – Blinded Veterans Association

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District #

District 1
District 2
District 3
District 4

Officers elected for year:

Beginning

Ending

Date of Election / Appointment

Officers Installed By

Officer

Officer Title

Officer Name

First

Last

Officer Email

Officer Phone

Officer Address

Address Line 1

Address Line 2

City

State

Zip Code

Officer #2

Officer Title

Officer Name

First

Last

Officer Email

Officer Phone

Officer Address

Address Line 1

Address Line 2

City

State

Zip Code

Officer #3

Officer Title

Officer Name

First

Last

Officer Email

Officer Phone

Officer Address

Address Line 1

Address Line 2

City

State

Zip Code

President's Signature

Secretary's Signature

Secretary Email