NJCDC Memorial Wreck Site Naming Form (one individual per form)

 

The ___________________________________________________________ (club)

names the following individual to the NJCDC Memorial Wreck Site:

 

---

 (please print name as you wish it to appear on the list)

 
The reason(s) we are naming this individual to the list is as follows (please attach additional sheets as needed):

 

---

 

---

 

---

 

---

---

---

---

---

---

Club President ________________________________ (print) _________________________

 

Club Delegate _________________________________ (print) _________________________

 

Date submitted _________________________________     Picture available  _________