Enter each individual’s information separately. You will receive a confirmation email for each entry.

Only submit names of individuals who are current members of ASCLS

Click here for a tutorial on downloading a membership roster. You will need to view a current roster to obtain the entrant's ASCLS Member ID.  

2018-19 State Leadership Roster Entry Form

Name of Submitter(*)
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Submitter Email(*)
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Please select one option(*)
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State Society
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State Position
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Name(*)
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Member Number(*)
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Email(*)
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Primary Phone Number
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