Reinstate/New Chapter Request

Your Name *

First

Last

Your Email: *

Your SCRA Member ID: *

Reinstate or New Chapter? *

Reinstating an Existing Chapter
Starting a New Chapter

Existing Chapter *

Unlisted Chapter Name:

Proposed New Chapter Name: *

Base/Post/Camp:

If Applicable

Chapter Physical Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Is your Mailing Address the same as Physical Address?

Yes
No

Chapter Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Would you like to show a Physical/Mailing Address on your Chapter Page?

Physical Address
Mailing Address
Prefer not to Display

This is not required to show on Chapter Page, but does help local SCRA members locate the Chapter.

2 to 4 "Spearhead" Members:

Please include 2-4 individuals assisting you in the setup/reinstatement of this chapter.
These may be the interim or permanent board members. If applicable, please include their title/position.

Number of Current Chapter Members:

Do you have a chapter specific mission statement?

Leave blank to use default wording

Chapter Page Link

Website
Facebook
Linkedin
Other
Not Available

We highly recommend setting up a Facebook Chapter page. This allows for updates directly to the members, and communication throughout the chapter. We will include a link on your chapter page to the FB group.

Website / URL

Facebook / URL

Linkedin Page / URL

Other? Please Specify:

Other Page / URL

Any Other information, questions, or comments?

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