Delegate Accreditation Form
Enter your delegate details and confirm executive approvals for EMSA mailings.
Club/League Name
*
Preferred Email for Mailings
*
example@example.com
Delegate Information
Delegate Full Name
*
First Name
Last Name
Delegate Position on the Board
*
1st Executive Authorization
1st Executive Full Name
*
First Name
Last Name
1st Executive Position
*
1st Executive Email
*
example@example.com
1st Executive Signature
*
2nd Executive Authorization
2nd Executive Full Name
*
First Name
Last Name
2nd Executive Position
*
2nd Executive Email
*
example@example.com
2nd Executive Signature
*
Agreement and Consent
*
By clicking the "Submit" button, you agree to the following: 1. The information provided is accurate to the best of your knowledge. 2. Two (2) executives have approved the submission of this delegate accreditation. 3. You understand and consent to the collection and processing of the submitted information.
Submit
Submit
Should be Empty: