MNEA RA Delegate Reporting Form

MNEA Representative Assembly
Delegate Reporting Form

Please report delegates for the MNEA Representative Assembly. For more information about reporting delegates to the MNEA R.A., contact Roxane Bly ( at (573) 644-9623. 

*indicates required field

Local Association
Local Association:*
Number of Members:

Person Reporting
Full Name:*

Primary Phone: (Home/Cell)*

Email Address:*


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