District Report Form

The following form is for use by ILCA District or Fleet Committees. Please complete all sections and submit to ILCA.You can use the TAB key to move between the boxes. Do not use the ENTER key as this will submit your form.

Name of District/Fleet if not your country:
Country

Number of members

If the number of members is not accurate as of today, please provide the date at which last count was made

How many Membership Cards
would you like to purchase?
(European Districts only)

Would you like labels delivered with your cards?

Y N

International Contact: (Name, address and contact numbers to appear in Handbook)

Name:
Address:


Tel (Home):	Tel (Office):
Tel (Mobile):	Can we publish your mobile number?	Y N
Fax:	E-mail:
District Website:
Skype Identity:

Address to which LaserWorld and Handbooks should be sent if different from above:

Attention:
Address:

President/Chairman/Fleet Captain:

Name:
Address:
Address:
Address:
Tel (Home):		Tel (Office):
Fax:		E-mail:
Skype Identity:

Secretary:

Name:
Address:


Tel (Home):		Tel (Office):
Fax:		E-mail:

Other Officers, eg Treasurer, Co-ordinator for Masters, Co-ordinator for Radial, Co-ordinatorr for 4.7, etc:

(Please provide as many names as necessary for your district)

01.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

02.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

03.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

04.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

05.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

06.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

07.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

08.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

09.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

10.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

11.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

12.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

13.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

14.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

15.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

16.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

17.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

18.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

19.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

20.	Position:
	Name:
	Tel (Home):	Tel (Office):
	Fax:	E-mail:

Form completed by:

Name		Position

When you have checked the information above, please don't forget to hit the Submit button!