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Use this form for registering the two Delegates and/or two Alternates from your state and for updating CoDA World Services regarding changes.

Name of Current Delegate/Alternate being replaced:	Delegate or Alternate?	Voting Entity

As the Delegate representing your state, your first name, last initial, phone number, and e-mail & address may be appearing in CoDA National contact Directories. Your authorization is required to release this information.

New Delegate information #1
Name		Phone
Address		City
State		Zip
Email		Authorization to post Y or N
New Delegate information #2
Name		Phone
Address		City
State		Zip
Email		Authorization to post Y or N
New Alternate information #1
Name 1		Phone
Address		City
State		Zip
Email		Authorization to post Y or N
New Alternate information #2
Name		Phone
Address		City
State		Zip
Email		Authorization to post Y or N

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