Member Club Information Form

NECCC uses this information to populate our Find a Club tool. This is a quick way for a viewer to find the clubs near a location on the map and connect to their website. The contact information of the club’s officers is important for us to be able to contact them with important information, mail competition awards, etc.

NECCC will not share this information on this website, or make it available to anyone other than NECCC officers and activity chairs.

You cannot save a partially filled form to complete at a later time. Please collect all the information required before starting the process.

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Name of Club *

Meeting Place Name *

Enter “None” if meetings are on-line only.

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Meeting Day/Days

Meeting Times

Meeting Format – choose one *

• Only In Person
• Only Zoom/Online
• Hybrid – In Person and Zoom/Online
• Some Meetings are Zoom/Online, Some Meetings are In Person

Number of Members *

Year Club Was Formed *

Website URL *

Competition Types – check all that apply *

• NONE
• Prints -Monochrome
• Prints – Color
• Digital
• Slides
• Video

Club Officials Contact Information

NECCC uses this information as a means for contacting club officers, mailing competition awards, etc. NECCC will not share this information on this website, or make available to anyone other than NECCC officers and activity chairs.

Club Representative Info

NECCC Rep Name (with any honors) *

Address *

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Email *

Year Started as Rep

This is used to calculate service awards.

Club President Info

Preident's Name (with any honors) *

Address *

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Email *

Treasurer's Name (with any honors)

Treasurer Name *

Address *

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Email *

Communications Person (with any honors)

The person responsible for communicating information to your club members.

Communication Leader Name *

Email *

Phone *

Layout Name President

Preparer Name *

Preparer Email *

Phone *

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