IPMS/USA Director of Local Chapters
Chapter Event Registration
Event Information
Start Date:
*
End Date:
Region:
1 - Northeast CT, MA, ME, NH, NY, RI, VT
2 - Mid-East DC, DE, MD, NJ, PA (Eastern), VA
3 - Southeast AL, FL, GA, MS, NC, SC, TN
4 - Great Lakes IN, KY, MI, OH, PA (Western), WV
5 - Midwest IA, IL, IN, MN, MO, NE, SD, WI
6 - Southwest AR, KS, LA, MO, OK, TX
7 - Northwest AK, ID, MT, OR, WA
8 - CA (Southern), NV (Southern)
9 - CA (Northern), NV (Northern)
10 - Rocky Mountain AZ, CO, NM, UT
11 - Florida
12 - Central Atlantic NC, SC
13 - Satellite, International, & Cyber Clubs
*
Category:
Local
Regional
National
*
Approval
RC
Yes
No
Name:
*
Website:
Host Chapter:
*
Event Location /
Name of Facility :
*
Address:
*
City:
*
State:
*
Does Event Location require additional insured to be named on the insurance?
Yes
No
*
If yes, please give name(s) of additional insured:
Contact Information
Contest Chairperson's Name:
*
Phone:
*
Address:
*
City:
*
State:
*
Zip:
*
E-Mail:
*
Remarks:
Submitter Information
Name:
*
E-Mail:
*
IPMS Number:
Expiration Date:
mm/dd/yyyy
* Required Fields.
Event Website Address URL's
MUST
begin with "http:// "
Please do not click the "Submit" button more than once!
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