District-Level Committee Update District-Level Committee Chair Information Change Form District-Level Committee Chair Information Change Form NameThis field is for validation purposes and should be left unchanged.District(Required)Select a DistrictAlexandria--Del Ray — 1Alexandria--Mount Vernon — 11Alexandria--Old Town — 45Alexandria--West End — 46Arlington — 2Centreville — 42Dulles — 4Eastern Shore — 27Fairfax — 5Falls Church — 6Fauquier — 35Fredericksburg — 30Hampton — 8Historic Virginia — 38Heart of Virginia — 9Loudoun — 10Manassas — 33Mountain View — 31New River Valley — 13Newport News — 12Norfolk — 14North Piedmont — 3Northern Neck — 15Ocean Front — 32Piedmont — 39Richmond--City of Richmond — 18Richmond--North East Richmond — 37Richmond--North of the James — 43Richmond--Richmond West — 44Richmond--South of the James — 29Richmond--Southside — 36Roanoke Valley — 19Shenandoah Valley — 22Skyline — 40South Central — 16South Piedmont — 17Southwest — 20Springfield — 21Vienna — 41Virginia Beach — 23Western Tidewater — 24Winchester — 26Woodbridge — 28Choose one.Delegate Area #Date change takes effect MM slash DD slash YYYY Committee Name(Required)Must Pick OneAccessibilitiesArchivesCooperation with Intergroup (District Intergroup Rep (DIR)))Cooperation with the Professional Community (CPC)Correctional FacilitiesFinance and BudgetGrapevineGrowthLiteraturePublic Information (PI)TreatmentWebsiteSelect a Committee NameCommittee Name - SecondaryPick One, If NeededAccessibilitiesArchivesCooperation with Intergroup (District Intergroup Rep (DIR)))Cooperation with the Professional Community (CPC)Correctional FacilitiesFinance and BudgetGrapevineGrowthLiteraturePublic Information (PI)TreatmentWebsiteSelect another Committee if your have a joined Committee (like CPC/PI). Select CPC in the first box and PI in the second.Type of Change District-Level Committee Chair Contact Change (existing to new) District-Level Committee Chair New Contact Information Update (name, address, email, phone) Current District-Level Committee ChairCurrent District-Level Committee Chair Name(Required) First Last Suffix Current District-Level Committee Chair Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current District-Level Committee Chair Email(Required) Current District-Level Committee Chair Phone(Required)New District-Level Committee ChairNew District-Level Committee Chair Name(Required) First Last Suffix New District-Level Committee Chair Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code New District-Level Committee Chair Personal Email(Required) New District-Level Committee Chair Phone(Required)Opt in I would like to be mailed a print version of the Committee Kit. This only applies to the following Committees: Accessibilities, Cooperation with the Professional Community, Corrections, Grapevine, Literature, Public Information, and/or Treatment.Update Committee Chair InformationI need to update:(Required) Name Address eMail Phone Select AllCurrent Name(Required) First Last Suffix Current Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current Personal Email(Required) Current Phone(Required)Updated Name(Required) First Last Suffix Updated Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Updated Personal Email(Required) Updated Phone(Required)This field is hidden when viewing the formNotes SectionAdditional InformationSubmitted By(Required) First Last Suffix Who is submitting this form?Submitted By Email(Required) Any additional notesNotes for clarification and any information
