This form collects your declaration for state captain, and that individual's contact information.
NOTE: The State Captain will need to register to  attend separately on the event on the event registration form.

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* 1. State:

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* 2. State Captain Name

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* 3. State Captain Address

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* 5. Declarations: The designated State Captain confirms that they will:

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* 6. Any additional questions, comments or concerns:

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