State Information Update Form

Association Information
Please fill in the information below for your ASSOCIATION.
State Association Name*
Combined Association? (Officer/Enlisted?)
- Yes
- No
Association Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Association Phone Number
Association FAX Number
Association DSN
Association Email
Enter Email Confirm Email
Association Website Address

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Executive Director's Information
Please fill in the information below for your EXECUTIVE DIRECTOR.
Name of Executive Director
Executive Director is:
- Full-Time
- Part-Time
Executive Director Since:
MM slash DD slash YYYY
Upload a photo of the Executive Director
Accepted file types: jpg, Max. file size: 15 MB.
Please upload a good quality, formal (if available) portrait of your Executive Director. Please send a JPG file over 500k in size, but less than 5meg in size. We will crop the file to fit our requirements, so you don't need to.
Executive Director's Address (if different from Association)
Street Address Address Line 2 City State ZIP Code
Executive Director's Phone Number (if different from Association)
Executive Director's Email Address
Enter Email Confirm Email

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President's Information
Please fill in the information below for your PRESIDENT.
Name of President
President's Tenure Ends
MM slash DD slash YYYY
President's Address (if different from Association)
Street Address Address Line 2 City State ZIP Code
President's Phone Number (if different from Association)
President's Email Address
Enter Email Confirm Email
Name of President Elect / 1st Vice President / Vice President

Please note both name and title.

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Paid Staff Information
A list of your paid staff members. Please list any changes from last year's directory.
Full Name
Title
Full- or Part-time Staff
- Full-Time
- Part-Time
Full Name
Title
Full- or Part-time Staff
- Full-Time
- Part-Time
Full Name
Title
Full- or Part-time Staff
- Full-Time
- Part-Time
Full Name
Title
Full- or Part-time Staff
- Full-Time
- Part-Time

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Upcoming Conference Dates
Conference Dates
2022 Conference dates 2023 Conference dates 2024 Conference dates
EXAMPLE: 5/21/18 to 5/25/18
Conference Cities
2022 Conference City 2023 Conference City 2024 Conference City

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Insurance Section
Name of Insurance Administrator
Insurance Carrier
Insurance Administrator's Address (if different from Association)
Street Address Address Line 2 City State ZIP Code
Insurance Administrator's Phone (if different from Association)
Insurance Staff
List staff ONLY if employed by the Association.
Insurance Staff #1 Name
Insurance Staff #1 Title
Insurance Staff #2 Name
Insurance Staff #2 Title
Insurance Staff #3 Name
Insurance Staff #3 Title

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Adjutant General Information
If different from last year.
Adjutant General's Name
Adjutant General's Address
Street Address Address Line 2 City State ZIP Code
Adjutant General's Phone
Adjutant General's FAX
Adjutant General's DSN
AUTHORIZED PERSON
Contact information for authorized person providing this information.
Authorized Person's Name*
Authorized Person's Phone*
Authorized Person's Email*
Enter Email Confirm Email
Name
This field is for validation purposes and should be left unchanged.

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Association Information