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American Pilgrims Local Chapter Request Form

Thank you for your interest in creating a new Local Chapter of American Pilgrims! The local chapters are the channels that connect the national organization to the community of pilgrims. We look forward to reviewing your submission. We would request that you give our chapter liaisons a couple of weeks to review your application but if you have a pressing question you can always reach them through Chapters@americanpilgrims.org.

Proposed Chapter Information:

Proposed chapter name. We strongly suggest a name that reflects the area served. See examples on the website's Local Chapters page. The organization retains final approval of the name chosen. *

Proposed chapter email. We strongly suggest an address that reflects the chapter's name and area served. See examples on the website's Local Chapters page. All addresses are @americanpilgrims.org. The organization retains final approval of the address chosen. *

A succinct description of the geographic area to be served: *

Nearest existing chapter: *

If you'd like help in determining which existing chapter is the closest, you can consult the chapter map on the Local Chapters page.

Comment about anything not addressed elsewhere:

Coordinator information:

It is strongly advised that chapters have more than a single coordinator. Nonetheless it is possible for a single person to submit an application. During the process of gaging interest in the formation of the chapter, additional coordinators may be identified.

Coordinator 1: ————————————————————

Name (1): *

Current member of American Pilgrims (1): *

Yes
No but will become one
Don't know

Phone (1): *

Email address (1) will be used for communication until the chapter is assigned its own address.

Email (1): *

Street address (1): *

Coordinator 2: ————————————————————

Name (2):

Current member of American Pilgrims (2):

Yes
No but will become one
Don't know

Phone (2):

Email (2):

Street address (2):

Coordinator 3: ————————————————————

Name (3):

Current member of American Pilgrims (3):

Yes
No but will become one
Don't know

Phone (3):

Email (3):

Address (3):

Coordinator Camino experience:

Coordinator 1: ——————————————————————————————

Type of experience (1): *

Walked or cycled
Volunteered
Other

Experience detail (1) (Routes, places, years): *

Comment (1):

Coordinator 2: ——————————————————————————————

Type of experience (2):

Walked or cycled
Volunteered
Other

Experience detail (2) (Routes, places, years):

Comment (2):

Coordinator 3: ——————————————————————————————

Type of experience (3):

Walked or cycled
Volunteered
Other

Experience detail (3) (Routes, places, years):

Comment (3):

Neon CRM by Neon One

Timeout Warning

American Pilgrims Local Chapter Request Form

Proposed Chapter Information:

Coordinator information:

Coordinator Camino experience: