Regional Club Information, On-Line Update Form

***     ALL FIELDS MUST BE FILLED OUT      ***

To:     Connie Smith, STCA Corresponding Secretary
         Web Technology Committee

Subject:     Updated Regional Club Information

Your Contact Information:
     Your Name: 
     and
     E-mail Address: 
     Note: If you do not include an email address, we may not be able to 
     contact you. The following information is optional.

     Street:    Apt# : 
     City:      State: 
     Zip:     

     Home Phone:  Home Fax: 
     Work Phone:  Work Fax: 

Updated Regional Club Information:
Regional Club Name:   

Club Officers: 
   (If New, Please provide the following information.)
     1) President:
     

     2) Corresponding Secretary:
     Insert Name Address & Phone Number here
      
    Corresponding Secretary's Email Address:
     


Club Newsletter: 
   (If New, Please provide the name of the Club's Newsletter.)
     1) Name of your Club's Newsletter
      

     2) Newsletter Editor:
     Insert Name Address & Phone Number here

    Newsletter Editor's Email Address:
     


Bagpiper Correspondent:
   Bagpiper Correspondent's Name  
   Bagpiper Correspondent's Email 


Breeder Referral:
     Insert Name Address & Phone Number here

    Breeder Referral Email Address:  


Rescue Contact:
     Insert Name Address & Phone Number here

    Rescue Contact's Email Address:  

Website address for additional information:

  (Your local club's Web site URL.)
   

I AFFIRM THAT ALL THE INFORMATION CONTAINED ON THIS FORM IS TRUE AND CORRECT.

Before you hit the Submit button:
1. Check to see that you have checked the information for accuracy.

2. We also suggest that you print a copy of the form so that a copy can be mailed to the Corresponding Secretary.

          
Click on the Submit button to send your new club information to the STCA Corresponding Secretary.  Note that an information copy of the message will also be sent to the STCA Webmaster.