Delegate Submission Form

Once your service unit elects its delegate(s) and alternate delegate(s), each elected individual must submit this form. The delegate/alternate term is October 1-September 30.
Delegate Region (Service Unit)*
Please provide your Service Unit number. Don't know your number? Look here.
Elected as*
- Delegate
- Alternate
I am registered as*
- Adult
- Girl (must be 14 years old by October 1, 2021)
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*
By providing my email and phone number, I give River Valleys consent to provide notice to Voting Members by a form of electronic communication such as email or phone.*
- Yes
- No

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