2021 AHEPA D6 Convention Delegate Form
Kindly complete the District 6 form below to submit delegates and alternates for the convention to be held on Saturday, June 19, 2021. Please indicate for each delegate either virtual or in-person attendance. Please submit this form no later than June 11.

If no information is available, please indicate N/A. Please provide an e-mail address for all delegates and alternates.

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Email *
Chapter Name and No. *
Date of Meeting *
MM
/
DD
/
YYYY
Number of Attendees *
Delegate 1- Member # *
Delegate 1 - Name *
Delegate 1 - Address *
Delegate 1 - Email address *
Delegate 1 - Attendance *
Delegate 2 - Member # *
Delegate 2 - Name *
Delegate 2 - Address *
Delegate 2 - Email address
Delegate 2 - Attendance
Clear selection
Delegate 3 - Member # *
Delegate 3 - Name *
Delegate 3 - Address *
Delegate 3 - Email address
Delegate 3 - Attendance
Clear selection
Delegate 4 - Member # *
Delegate 4 - Name *
Delegate 4 - Address *
Delegate 4 - Email address
Delegate 4 - Attendance
Clear selection
Delegate 5 - Member # *
Delegate 5 - Name *
Delegate 5 - Address *
Delegate 5 - Email address
Delegate 5 - Attendance
Clear selection
Delegate 6 - Member # *
Delegate 6 - Name *
Delegate 6 - Address *
Delegate 6 - Email address
Delegate 6 - Attendance
Clear selection
Alternate 1 - Member #
Alternate 1 - Name
Alternate 1 - Address
Alternate 1 - Email address
Alternate 1 - Attendance
Clear selection
Alternate 2 - Member #
Alternate 2 - Name
Alternate 2 - Address
Alternate 2 - Email address
Alternate 2 - Attendance
Clear selection
Alternate 3 - Member #
Alternate 3 - Name
Alternate 3 - Address
Alternate 3 - Email address
Alternate 3 - Attendance
Clear selection
Alternate 4 - Member #
Alternate 4 - Name
Alternate 4 - Address
Alternate 4 - Email address
Alternate 4 - Attendance
Clear selection
Alternate 5 - Member #
Alternate 5 - Name
Alternate 5 - Address
Alternate 5 - Email address
Alternate 5 - Attendance
Clear selection
Alternate 6 - Member #
Alternate 6 - Name
Alternate 6 - Address
Alternate 6 - Email address
Alternate 6 - Attendance
Clear selection
Past District Governor, Past Supreme President, or District Lodge Officer
Member # and E-Mail
Attendance
Clear selection
Past District Governor, Past Supreme President, or District Lodge Officer
Member # and E-Mail
Attendance
Clear selection
Past District Governor, Past Supreme President, or District Lodge Officer
Member # and E-Mail
Attendance
Clear selection
Please type your name below, which will serve as the electronic signature attesting to the information submitted on behalf of the President and Secretary *
After completing the above delegate registration form for the 2021 convention, kindly submit the fee of $25 (virtual) or $50 (in-person) per member by check payable to Leonidas AHEPA Chapter #77, c/o Holy Trinity Greek Orthodox Church, 214 Court St.., Binghamton, NY 13901. The deadline to receive the delegate form and fees is Friday, June 11, 2021. No delegate forms will be accepted after this date.  

In order to vote at the district convention all delegates and alternates, must be in good standing, and paid through 2020 to the district and 2021 to national.

Any Chapters who have not yet paid their $7 per member district per capita, should immediately forward the amount payable to AHEPA District 6 c/o Brother Peter Ragoussis, 192-22 37th Ave., Flushing, NY 11358. Please contact District Secretary Chris Pappis with any questions at secretary@ahepad6.com.

A copy of your responses will be emailed to the address you provided.
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