CO Officer Update Form

CONSTITUENT ORGANIZATION OFFICER
UPDATE FORM

Every constituent organization must complete this form once a year regardless of the term of office for the leadership listed. Please upload a copy of your current bylaws with this form. Due dates are listed below:

Leadership year begins January 1 – Officer Update due no later than January 15
Leadership year begins July 1 – Officer Update due no later than July 15
If leadership year begins in any other month, Officer Update due no later than the 15th of same month.

If you have changes to your leadership during the leadership year, please email coadministrator@aapa.org.

* Date:

* Name of Individual Submitting Form:

Organization Information:

* Organization Name:

* Street Address/P.O. Box:

* City:

* State:

* Zip Code:

* Phone Number:

* Fax Number:

* E-mail Address:

* Website Address:

* Organization Primary Contact:

Executive Director or Paid Administrative Staff if Applicable:

Organization Officers/Leaders:

* Leadership Term:

January - December

July - June

Other - Please specify:

* President:

Position not required in bylaws

Position required in bylaws, but currently vacant

Position required in bylaws and filled - Name:

* Does the President position have a board vote?

Yes

No

* President Elect:

Position not required in bylaws

Position required in bylaws, but currently vacant

Position required by bylaws and filled - Name:

* Does the President Elect position have a board vote?

Yes

No

* Past President:

Position not required in bylaws

Position required in bylaws, but currently vacant

Position required by bylaws and filled - Name:

* Does the Past President position have a board vote?

Yes

No

* Vice President:

Position not required in bylaws

Position required in bylaws, but currently vacant

Position required by bylaws and filled - Name:

* Does the Vice President position have a board vote?

Yes

No

* Secretary:

Position not required in bylaws

Position required in bylaws, but currently vacant

Position is a combined Secretary/Treasurer position

Position required by bylaws and filled - Name:

* Does the Secretary position have a board vote?

Yes

No

* Treasurer:

Position not required in bylaws

Position required in bylaws, but currently vacant

Position is a combined Secretary/Treasurer position

Position required by bylaws and filled - Name:

* Does the Treasurer position have a board vote?

Yes

No

Director at Large:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

Director at Large:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

Director at Large:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

Director at Large:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

Student Representative:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

Student Representative:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

Student Representative:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

Student Representative:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* CME Contact:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* Legislative Contact:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* Newsletter Contact:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* Membership Contact:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* Minority Affairs/Diversity Contact:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* Public Education Contact:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* Reimbursement Contact:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* Nominating/Election Contact:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* Website Contact:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* Historian:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* Student Affairs Contact:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* Judicial Affairs Contact:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

* Finance Contact:

* Is position required in bylaws?

Yes

No

* Does position have a board vote?

Yes

No

Chief Delegate:

	Name	Email
1.

Delegates:

	Name	Email
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Alternates:

	Name	Email
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Demographics:

* Fiscal year begins:

* Membership Term:

January - December

July - June

Anniversary (12 months)

Other - Please specify:

* Number of members and dues fees by membership category (if information is not available please place a zero in response box):

	Fellow	Affiliate	Student	Associate	Sustaining	Physician	Other
Number
Dues

Please attach a copy of your current bylaws or email to coadministrator@aapa.org:

Additional Comments:

* Indicates Response Required