This form is for District 14E use only – you are still required to make a New Officers Report at the LCI website.

e.g.: 2014-2015
e.g. 05/2014
First Name - Last Name Spouse Name Address City/State/Zip Phone (H) - Phone (C) - Phone (W) EMail Address
First Name - Last Name Spouse Name Address City/State/Zip Phone (H) - Phone (C) - Phone (W) EMail Address
First Name - Last Name Spouse Name Address City/State/Zip Phone (H) - Phone (C) - Phone (W) EMail Address
First Name - Last Name Spouse Name Address City/State/Zip Phone (H) - Phone (C) - Phone (W) EMail Address
Day / Time Name of Place Location Address
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