DEPARTMENT CHAIRMAN INTEREST SURVEY
  PURPOSE: This survey is to find out names of members who may have the desire or interest in serving as a Department Chairman, Assistant – Secretary, Conductor, Guard, Soloist, Musician, Hospital Representative or Hospital Deputy, Color Bearers, Floor Page.   
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Email *
Name *
Address *
City, State Zip *
Phone *
District *
Auxiliary Number *
Interested in Department Chairmanship *
If yes, please list in order of preference 1-10
1
2
3
4
5
6
7
8
9
10
Americanism/Patriotic Instructor
Buddy Poppy/Natl. HOme
Disaster
Historian
Hospital
Legislative
Scholarships
Membership
Mentoring for Leadership
Program Coordinator
Veterans & Family Support
Hospital Representative? *
Hospital Deputy? *
Interested in assisting, Floor Work? (mark with order of preference by using 1-10)
1
2
3
4
5
6
7
8
9
10
Banner Bearer
Color Bearers (#1, #2, #3, #4)
Conductor
Flag Bearer
Floor Page
Guard
Hospitality Room
Musician and/or Soloist
POW/MIS Flag Bearer
Secretary
Treasurer
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