Submit these forms to the NSS Chapters VP, your regional coordinator,
and a print copy to: NSS Headquarters, 1155 15th Street NW, Suite 500,
Washington, DC 20005, by February 15

Chapter Name:	
Address of Record*	
City/State/Zip:	
Phone Number:		Fax Number:	
Email Address:	

*This address will be printed in Ad Astra magazine and other NSS
publications and will be posted on the web. Notify the NSS Chapters
VP for changes between annual reports.

President/Contact Name:	
Address:	
City/State/Zip:	
Phone Number:		Fax Number:	
Email Address:	
Chapter Web Site URL:  

Newsletter Name:	
Editor/Contact Name:	
Address:	
City/State/Zip:	
Phone Number:		Fax Number:	
Email Address:	
Newsletter Web Site URL:  

(   )	A one-page (or more) Chapter Activities Report is attached
(   )	A current Chapter Membership list is attached

Chapter Bylaws Status (Please check one)
(   )	Our Bylaws have not changed in the past fiscal year, therefore a copy is not attached.
(   )	Our Bylaws have changed in the past fiscal year and a copy is attached

IRS Employer Identification Number (U.S. chapters only):        ____     __
(   )	Proof of our IRS Form 990-N (or other 990) filing is attached (U.S. chapters only)
(   )	A Chapter Financial Report is attached (U.S. chapters not filing separately)
 

Other Chapter Officers (attach additional sheets if necessary)
Vice-President:	
Address:	
City:	
State/Zip:	
Phone:	
Email:	

Secretary:	
Address:	
City:	
State/Zip:	
Phone:	
Email:	

Treasurer:	
Address:	
City:	
State/Zip:	
Phone:	
Email:	

Title:	
Name:	
Address:	
City:	
State/Zip:	
Phone:	
Email:	
 
Title:	
Name:	
Address:	
City:	
State/Zip:	
Phone:	
Email:	

Title:	
Name:	
Address:	
City:	
State/Zip:	
Phone:	
Email:	


Title:	
Name:	
Address:	
City:	
State/Zip:	
Phone:	
Email: