VOSH APPLICATION FOR PROVISIONAL CHAPTER*
TO BE KNOWN AS
VOSH-________________,
WHICH, IF GRANTED, WILL PROVIDE VOSH MEMBERSHIP OPPORTUNITIES FOR PEOPLE RESIDING IN THE GEOGRAPHICAL AREA OF _____________________________________________
ON THIS DATE,___________________________,THE UNDERSIGNED HUMANITARIANS HEREBY APPLY FOR AFFILIATION TO VOSH/INTERNATIONAL AS A PROVISIONAL CHAPTER.
A. FORMATION OF NON PROFIT CORPORATION, FEDERAL TAXPAYER IDENTIFICATION NUMBER AND CURRENT BANKING ARRANGEMENTS
ENCLOSED FOR APPROVAL OF THE EXECUTIVE BOARD OF VOSH/INTERNATIONAL ARE THE FOLLOWING DOCUMENTS:
1. COPY OF THE FILED ARTICLES OF INCORPORTION OF THE PROPOSED CHAPTER AS A NOT FOR PROFIT CORPORATION IN THE STATE OF ______________
2. COPY OF THE CURRENT BY-LAWS OF THE NOT FOR PROFIT CORPORATION FORMED FOR THE PROPOSED CHAPTER.
3. COPY OF A RECENT STATEMENT FOR THE CURRENT CHECKING ACCOUNT FOR THE PROPOSED CHAPTER'S OPERATING FUNDS.
4. A COPY OF ANY CURRENT DOCUMENT INDICATING THE NON-PORIFT CORPORATION'S TAXPAYER IDENTIFICATION NUMBER AS AWARDED BY THE INTERNAL REVENUE SERVICE.
B. PROVISIONAL CHAPTER LEADERSHIP
THE CHARTER OFFICERS OF THIS PROVISIONAL CHAPTER WILL BE:
PRESIDENT ______________________________________
OCCUPATION______________________________________
ADDRESS_________________________________________
_________________________________________
TELEPHONE ______________________________________
EMAIL ADDRESS___________________________________
FAX ____________________________________________
DIRECTOR OF CORPORATION? (YES) (N0)
-underline appropriate response
VICE PRESIDENT _________________________________
OCCUPATION______________________________________
ADDRESS_________________________________________
_________________________________________
TELEPHONE ______________________________________
EMAIL ADDRESS___________________________________
FAX ____________________________________________
DIRECTOR OF CORPORATION? (YES) (N0)
-underline appropriate response
SECRETARY ______________________________________
OCCUPATION______________________________________
ADDRESS_________________________________________
_________________________________________
TELEPHONE ______________________________________
EMAIL ADDRESS___________________________________
FAX ____________________________________________
DIRECTOR OF CORPORATION? (YES) (N0)
-underline appropriate response
TREASURER ______________________________________
OCCUPATION______________________________________
ADDRESS_________________________________________
_________________________________________
TELEPHONE ______________________________________
EMAIL ADDRESS___________________________________
FAX ____________________________________________
DIRECTOR OF CORPORATION? (YES) (N0)
-underline appropriate response
THE NAMES AND ADDRESSES OF THE DIRECTORS OF THE CHAPTER NOT FOR PROFIT CORPORATION, IF NOT LISTED ABOVE ARE:
__________________________Address________________________
__________________________Address________________________
C. PRESENT MEMBERSHIP, ADVISING CHAPTER, INITIAL PROJECT OR MISSION
The number of present members of the Proposed Chapter is
__________, of whom _______ (number) are Optometrists licensed to practice in the geographical area to be served by the proposed chapter.
We have formed an advisory relationship with the presently existing VOSH Chapter known as ____________________________ and our contact person in that Chapter is
_________________________(address)_________________________
The proposed Chapter's initial general activities for its first year of provisional affiliation will be:
The proposed Chapter's initial Project or Mission during its first year of provisional affiliation will be conducted with the advice and counsel of our Advising Chapter stated above. We propose the following Project or Mission:
If granted Provisional Affiliation with VOSH-International, we agree on behalf of this Provisional Chapter to accept and govern ourselves and our activities by all relevant language in the VOSH-International Constitution, Bylaws, and lawful directives of the Executive Board and Board of Directors of VOSH-International.
*Provisional chapter is subject to approval by the VI Board of Directors after one year.
President__________________________________
Secretary__________________________________
Please return this form and a check for first year dues in the amount of $100 (One Hundred U.S.A. Dollars) to:
Charles H. Covington, Sr.
Secretary/Treasurer, VOSH/International
111 Linda Lane
Lake Mary, FL 32746-4208
VOSH-________________,
WHICH, IF GRANTED, WILL PROVIDE VOSH MEMBERSHIP OPPORTUNITIES FOR PEOPLE RESIDING IN THE GEOGRAPHICAL AREA OF _____________________________________________
ON THIS DATE,___________________________,THE UNDERSIGNED HUMANITARIANS HEREBY APPLY FOR AFFILIATION TO VOSH/INTERNATIONAL AS A PROVISIONAL CHAPTER.
A. FORMATION OF NON PROFIT CORPORATION, FEDERAL TAXPAYER IDENTIFICATION NUMBER AND CURRENT BANKING ARRANGEMENTS
ENCLOSED FOR APPROVAL OF THE EXECUTIVE BOARD OF VOSH/INTERNATIONAL ARE THE FOLLOWING DOCUMENTS:
1. COPY OF THE FILED ARTICLES OF INCORPORTION OF THE PROPOSED CHAPTER AS A NOT FOR PROFIT CORPORATION IN THE STATE OF ______________
2. COPY OF THE CURRENT BY-LAWS OF THE NOT FOR PROFIT CORPORATION FORMED FOR THE PROPOSED CHAPTER.
3. COPY OF A RECENT STATEMENT FOR THE CURRENT CHECKING ACCOUNT FOR THE PROPOSED CHAPTER'S OPERATING FUNDS.
4. A COPY OF ANY CURRENT DOCUMENT INDICATING THE NON-PORIFT CORPORATION'S TAXPAYER IDENTIFICATION NUMBER AS AWARDED BY THE INTERNAL REVENUE SERVICE.
B. PROVISIONAL CHAPTER LEADERSHIP
THE CHARTER OFFICERS OF THIS PROVISIONAL CHAPTER WILL BE:
PRESIDENT ______________________________________
OCCUPATION______________________________________
ADDRESS_________________________________________
_________________________________________
TELEPHONE ______________________________________
EMAIL ADDRESS___________________________________
FAX ____________________________________________
DIRECTOR OF CORPORATION? (YES) (N0)
-underline appropriate response
VICE PRESIDENT _________________________________
OCCUPATION______________________________________
ADDRESS_________________________________________
_________________________________________
TELEPHONE ______________________________________
EMAIL ADDRESS___________________________________
FAX ____________________________________________
DIRECTOR OF CORPORATION? (YES) (N0)
-underline appropriate response
SECRETARY ______________________________________
OCCUPATION______________________________________
ADDRESS_________________________________________
_________________________________________
TELEPHONE ______________________________________
EMAIL ADDRESS___________________________________
FAX ____________________________________________
DIRECTOR OF CORPORATION? (YES) (N0)
-underline appropriate response
TREASURER ______________________________________
OCCUPATION______________________________________
ADDRESS_________________________________________
_________________________________________
TELEPHONE ______________________________________
EMAIL ADDRESS___________________________________
FAX ____________________________________________
DIRECTOR OF CORPORATION? (YES) (N0)
-underline appropriate response
THE NAMES AND ADDRESSES OF THE DIRECTORS OF THE CHAPTER NOT FOR PROFIT CORPORATION, IF NOT LISTED ABOVE ARE:
__________________________Address________________________
__________________________Address________________________
C. PRESENT MEMBERSHIP, ADVISING CHAPTER, INITIAL PROJECT OR MISSION
The number of present members of the Proposed Chapter is
__________, of whom _______ (number) are Optometrists licensed to practice in the geographical area to be served by the proposed chapter.
We have formed an advisory relationship with the presently existing VOSH Chapter known as ____________________________ and our contact person in that Chapter is
_________________________(address)_________________________
The proposed Chapter's initial general activities for its first year of provisional affiliation will be:
The proposed Chapter's initial Project or Mission during its first year of provisional affiliation will be conducted with the advice and counsel of our Advising Chapter stated above. We propose the following Project or Mission:
If granted Provisional Affiliation with VOSH-International, we agree on behalf of this Provisional Chapter to accept and govern ourselves and our activities by all relevant language in the VOSH-International Constitution, Bylaws, and lawful directives of the Executive Board and Board of Directors of VOSH-International.
*Provisional chapter is subject to approval by the VI Board of Directors after one year.
President__________________________________
Secretary__________________________________
Please return this form and a check for first year dues in the amount of $100 (One Hundred U.S.A. Dollars) to:
Charles H. Covington, Sr.
Secretary/Treasurer, VOSH/International
111 Linda Lane
Lake Mary, FL 32746-4208