Alpha Chi Sigma Coat of Arms

Alpha Chi Sigma 57th Biennial Conclave

Notice of Delegate Election

Chapter Name: *

Our Chapter has elected the following Conclave delegate and alternates for the

57th Biennial Conclave.

These Brothers expect to return to the chapter as active members for the remainder

of the 2024 calendar year.

If the delegate cannot attend Conclave, the delegate and the Master Alchemist or professional chapter president must notify the first or second alternate to make arrangements

to attend Conclave.

Please notifiy the National Office immediately of any changes.

This form is due by May 1, 2024.

Delegate

Delegate First Name *

Delegate Last Name *

Summer Address (June 1 to August 15) *

City *

State *

Zip *

E-mail Address *

Cell Phone Number *

First Alternate Delegate

First Alternate Delegate First Name

First Alternate Delegate Last Name

Summer Address (June 1 to August 15)

City

State

Zip

E-mail Address

Cell Phone Number

Second Alternate Delegate

Second Alternate Delegate First Name

Second Alternate Delegate Last Name

Summer Address (June 1 to August 15)

City

State

Zip

E-mail Address

Cell Phone Number